Burden and Long-Term Trends of Viral Hepatitis in China: A National and Provincial Analysis

Abstract

Objective

Viral hepatitis remains a major global health threat, causing approximately 1.3 million deaths in 2022. Despite substantial advances in vaccination and clinical treatment, it continues to impose a heavy disease burden across China. Existing studies have largely focused on single hepatitis subtypes and national epidemiological trends, with limited evidence on provincial heterogeneity. To fill this research gap, this study aimed to conduct a refined, region-specific epidemiological assessment of viral hepatitis in China.

Methods

Data were extracted from the Global Burden of Disease Study 2021 (GBD 2021) and the China Public Health Science Data Center to systematically analyze the epidemiological characteristics and spatiotemporal trends of viral hepatitis in China over the past three decades.

Results

The overall burden of viral hepatitis in China decreased substantially over the study period, with obvious regional heterogeneity. Acute hepatitis A, B and E, as well as chronic hepatitis B and C, all presented prominent downward trends. The fastest declines in incidence were observed in acute hepatitis B (estimated annual percentage change [EAPC] = −3.03) and chronic hepatitis B (EAPC = −4.74). Notably, males suffered a higher disease burden for nearly all outcomes, except for HCV-related hepatocellular carcinoma, which predominantly affected females. Furthermore, provincial-level analysis indicated marked regional disparities: Xizang maintained a high incidence rate, while Beijing exhibited low incidence accompanied by strikingly high hepatitis-related mortality, suggesting a notable decoupling between infection prevalence and mortality.

Conclusions

China has achieved remarkable reductions in the overall burden of viral hepatitis, attributable to comprehensive public health interventions such as universal vaccination, standardized screening and improved sanitation conditions. Nevertheless, residual burdens in vulnerable populations and striking regional inequalities warrant targeted prevention and control strategies to reduce disease disparities nationwide.

Keywords

Viral hepatitis / China / Global Burden of Disease (GBD) / China Public Health Science Data Center / Disease burden

References

[1] Odenwald MA, Paul S. Viral hepatitis: Past, present, and future. World J Gastroenterol., 2022, 28(14): 1405-1429.

[2] Su X, Zheng L, Zhang H, et al.. Secular trends of acute viral hepatitis incidence and mortality in China, 1990 to 2019 and Its prediction to 2030: the global burden of disease study 2019. Front Med., 2022, 9. ArticleID: 842088

[3] Burki T. WHO's 2024 global hepatitis report. Lancet Infect Dis., 2024, 24(6): e362-e363.

[4] Gabrielli F, Alberti F, Russo C, et al. Treatment options for hepatitis A and E: a non-systematic review. Viruses. 2023;15(5).

[5] Jia J. Advances in the diagnosis and treatment of viral hepatitis B and C in China. Chin Med J., 2021, 135(4): 379-380.

[6] Cao G, Liu J, Liu M. Trends in mortality of liver disease due to hepatitis B in China from 1990 to 2019: findings from the Global Burden of Disease Study. Chin Med J., 2022, 135(17): 2049-2055.

[7] Negro F, Lok AS. Hepatitis D: a review. JAMA., 2023, 330(24): 2376-2387.

[8] Liang X, Chen Q, Tang H, et al.. Prevalence of hepatitis D virus antibody positivity in Chinese patients with chronic hepatitis B virus infection. J Clin Transl Hepatol., 2025, 13(4): 278-283

[9] GBD 2021 Risk Factors Collaborators. Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet., 2024, 403(10440): 2162-2203.

[10] GBD 2021 Forecasting Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet., 2024, 403(10440): 2133-2161.

[11] Sun P, Yu C, Yin L, et al.. Global, regional, and national burden of female cancers in women of child-bearing age, 1990–2021: analysis of data from the global burden of disease study 2021. eClinicalMedicine., 2024, 74. ArticleID: 102713

[12] Peng J, Yuan Y, Zhang J, et al.. Global, regional and national burden of inflammatory bowel disease in females from 1990 to 2021: an analysis of the global burden of disease study 2021. Front Glob Womens Health., 2025, 6: 1580451.

[13] Zeng DY, Li JM, Lin S, et al.. Global burden of acute viral hepatitis and its association with socioeconomic development status, 1990–2019. J Hepatol., 2021, 75(3): 547-556.

[14] Chen CM, Chen SC, Yang HY, et al.. Hospitalization and mortality due to hepatitis A in Taiwan: a 15-year nationwide cohort study. J Viral Hepat., 2016, 23(11): 940-945.

[15] Lloyd AR, Franco RA. Sexual transmission of viral hepatitis. Infect Dis Clin North Am., 2023, 37(2): 335-349.

[16] Ruggieri A, Gagliardi MC, Anticoli S. Sex-dependent outcome of hepatitis B and C viruses infections: synergy of sex hormones and immune responses. Front Immunol., 2018, 9: 2302.

[17] Giefing-Kröll C, Berger P, Lepperdinger G, et al.. How sex and age affect immune responses, susceptibility to infections, and response to vaccination. Aging cell., 2015, 14(3): 309-321.

[18] Monti D, Lantos E, Lancki N, et al.. Optimizing care for reproductive-age women with hepatitis C virus. J Womens Health (Larchmt)., 2025, 34(8): 1043-1049.

[19] Saleh E, Rodriguez M. Adopting the 2023 CDC early testing for perinatal hepatitis C: call to action for pediatric primary care providers. J Pediatric Infect Dis Soc. 2024;13(Supplement_5):s153−s158.

[20] Ferreira J, Sheflin-Findling S. Update on pediatric hepatitis C infection. Curr Gastroenterol Rep., 2025, 27(1): 18.

[21] Chen Q, Ma J, Wu R, et al.. Factors influencing hepatitis B vaccination intention and behavior among college students in Tibet: Insights from the expanded theory of planned behavior. Hum Vaccin Immunother., 2025, 21(1): 2452026.

[22] Du X, Mi J, Cheng H, et al.. Uptake of hepatitis C direct-acting antiviral treatment in China: a retrospective study from 2017 to 2021. Infect Dis Poverty., 2023, 12(1): 28.

[23] Wu M, Ma J, Wang X, et al.. Cost-effectiveness and return on investment of hepatitis C virus elimination in China: A modelling study. Clin Mol Hepatol., 2025, 31(2): 394-408.

[24] Zheng J, Zhang N, Shen G, et al.. Spatiotemporal and seasonal trends of class A and B notifiable infectious diseases in China: retrospective analysis. JMIR Public Health Surveill., 2023, 9. ArticleID: e42820

[25] Wang Y, Zhao C, Qi Y, et al.. Hepatitis E Virus. Adv Exp Med Biol., 2016, 948: 1-16.

[26] Liu Z, Lin C, Mao X, et al.. Changing prevalence of chronic hepatitis B virus infection in China between 1973 and 2021: a systematic literature review and meta-analysis of 3740 studies and 231 million people. Gut., 2023, 72(12): 2354-2363.

Funding

2025 Regional Innovation Project of Hubei Provincial Department of Science and Technology(No. 2025EIA001)

RIGHTS & PERMISSIONS

The Author(s), under exclusive licence to the Huazhong University of Science and Technology