Global Trends and Health Inequalities in Acute Hepatitis E Burden: A Joinpoint Regression and Cross-Country Inequality Analysis, 1990–2021

Acute hepatitis E (AHE) disproportionately affects regions with diverse socioeconomic conditions. This study aims to assess the trends in AHE burden and health inequalities from 1990 to 2021. Utilising data from the Global Burden of Disease 2021, joinpoint regression was employed to identify significant trends. Cross-country inequality analysis was conducted to quantify the distributive inequalities in the burden of AHE. The trends of AHE incidence, prevalence, deaths and disability-adjusted life years (DALYs) rate have experienced a marked decrease from 1990 to 2021, reaching the lowest recorded in 2021. However, the numbers of those continued to increase. An inverse relationship was found between AHE disease rate and sociodemographic index (SDI) levels. The joinpoint regression analysis confirmed a downward trend of AHE globally and in the five SDI levels. Notably, incidence and prevalence rates in high-middle SDI increased from 2015, while those in high SDI slowed down from 2001. Mortality and DALYs rates showed a deceleration in high-middle SDI and a rebound in high SDI from 2009 to 2021. Cross-country inequality analysis disclosed that lower SDI countries disproportionately bear a higher AHE burden, with the magnitude of these inequalities decreasing over time. The study uncovered an inverse correlation between the AHE disease rate and SDI level. Despite a consistent decline in hepatitis E virus disease rate across the five SDI levels, the disparity in burden persists, with developing regions retaining a relatively elevated load. Meanwhile, developed regions exhibit a resurgence, characterised by an upward trend. This dynamic epidemiological shift underscores the ongoing need for vigilant monitoring and adaptable approaches in the management of the disease.