Global, regional, and national burdens of liver disease due to hepatitis B in women of childbearing age, 1990 to 2021: an analysis of the Global Burden of Disease Study

Abstract

Background

Women of childbearing age with hepatitis B are at risk for progression to life-threatening liver disease and vertical and horizontal transmission and have an increased risk for poor fetal health outcomes during pregnancy. Estimates of the burden of liver disease due to hepatitis B are scarce for women of childbearing age.

Objective

This study aimed to use data from the Global Burden of Disease (GBD) Study to quantify the burden of liver disease due to hepatitis B in women of childbearing age at the global, regional, and national levels.

Study Design

Annual counts of incident cases, prevalent cases, and deaths, and rates of incidence, prevalence, and mortality of liver disease due to hepatitis B in women of childbearing age (15–49 years) between 1990 and 2021 were collected from the GBD 2021. Percentage changes in counts of incident cases, prevalent cases, and deaths, and estimated annual percentage changes (EAPCs) in rates of incidence, prevalence, and mortality were calculated to quantify their temporal trends.

Results

Globally, the absolute counts of liver disease due to hepatitis B in women of childbearing age decreased 3.45% from 18.45 million in 1990 to 17.82 million in 2021 for incident cases, by 1.08% from 74.50 million in 1990 to 73.35 million in 2021 for prevalent cases, and by 3.74% from 36.38 thousand in 1990 to 35.02 thousand in 2021 for deaths, respectively. The global rates of incidence, prevalence, and mortality of liver disease due to hepatitis B in women of childbearing age decreased by an average of 1.26% (95% confidence interval [CI]: 1.16%, 1.35%), 1.21% (95% CI: 1.12%, 1.31%), and 1.49% (95% CI: 1.42%, 1.55%) per year between 1990 and 2021, respectively. At the regional level, an increasing trend in the mortality of liver disease due to hepatitis B in women of childbearing age between 1990 and 2021 was observed in Australasia (EAPC=0.46; 95% CI: 0.23, 0.68), Eastern Europe (EAPC=3.39; 95% CI: 2.34, 4.45), and High-income North America (EAPC=0.77; 95% CI: 0.57, 0.97). At the national level, a significant increasing trend in the incidence rate, prevalence rate, and/or mortality rate of liver disease due to hepatitis B in women of childbearing age between 1990 and 2021 was observed in several countries, such as Denmark, the United Kingdom, and Ukraine. As of 2023, there were still 53 countries worldwide that have not yet introduced the hepatitis B birth dose vaccination in the national immunization program. These countries are mainly located in Sub-Saharan Africa, with a high incidence of liver disease due to hepatitis B in women of childbearing age and a high total fertility rate.

Conclusion

The global rates of incidence, prevalence, and mortality of liver disease due to hepatitis B in women of childbearing age decreased between 1990 and 2021. An unfavorably increasing trend in the incidence rate, prevalence rate, and/or mortality rate of liver disease due to hepatitis B in women of childbearing age was observed in several countries, such as Denmark, the United Kingdom, and Ukraine. Thus, comprehensive strategies of screening, treatment, and/or vaccination services are important for reducing vertical transmission, horizontal transmission, and total disease burden of hepatitis B in women of childbearing age.