Hepatitis B and C in Europe: an update from the Global Burden of Disease Study 2019

Background: In 2016, the World Health Assembly adopted the resolution to eliminate viral hepatitis by 2030. This study aims to provide an overview of the burdens of hepatitis B virus (HBV) and hepatitis C virus (HCV) in Europe and their changes from 2010 to 2019 using estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods: We used GBD 2019 estimates of the burden associated with HBV-related and HCV-related diseases: acute hepatitis, cirrhosis and other chronic liver diseases, and liver cancer. We report total numbers and age-standardised rates per 100 000 for mortality, prevalence, incidence, and disability-adjusted life-years (DALYs) from 2010 to 2019. For each HBV-related and HCV-related disease and each measure, we analysed temporal changes and percentage changes for the 2010-19 period. Findings: In 2019, across all age groups, there were an estimated 208 million (95% uncertainty interval [UI] 166 to 254) incident cases of acute hepatitis B and 049 million (042 to 057) of hepatitis C in Europe. There were an estimated 824 million (756 to 888) prevalent cases of HBV-related cirrhosis and 1187 million (977 to 1441) of HCV-related cirrhosis, with 2492 thousand (1986 to 3103) deaths due to HBV-related cirrhosis and 3689 thousand (2994 to 4556) deaths due to HCV-related cirrhosis. Deaths were estimated at 900 thousand (688 to 1162) due to HBV-related liver cancer and 2307 thousand (1895 to 2731) due to HCV-related liver cancer. Between 2010 and 2019, the age-standardised incidence rate of acute hepatitis B decreased (-2214% [95% UI -3544 to -598]) as did its age-standardised mortality rate (-3327% [-4303 to -2549]); the age-standardised prevalence rate (-2060% [-2209 to -1910]) and mortality rate (-3319% [-3782 to -2813]) of HBV-related cirrhosis also decreased in this time period. The age-standardised incidence rate of acute hepatitis C decreased by 324% (117 to 502) and its age-standardised mortality rate decreased by 3573% (2348 to 4775) between 2010 and 2019; the age-standardised prevalence rate (-637% [-811 to -432]), incidence rate (-587% [-1124 to -101]), and mortality rate (-1111% [-1654 to -553]) of HCV-related cirrhosis also decreased. No significant changes were observed in age-standardised rates of HBV-related and HCV-related liver cancer, although we observed a significant increase in numbers of cases of HCV-related liver cancer across all ages between 2010 and 2019 (1641% [281 to 3091] increase in prevalent cases). Substantial reductions in DALYs since 2010 were estimated for acute hepatitis B (-2782% [-3692 to -2024]), acute hepatitis C (-2707% [-1597 to -3934]), and HBV-related cirrhosis (-3070% [-3575 to -2503]). A moderate reduction in DALYs was estimated for HCV-related cirrhosis (-619% [-019 to -1257]). Only HCV-related liver cancer showed a significant increase in DALYs (1037% [481-1663]). Changes in age-standardised DALY rates closely resembled those observed for overall DALY counts, except for HCV-liver related cancer (-284% [-775 to 263]). Interpretation: Although decreases in some HBV-related and HCV-related diseases were estimated between 2010 and 2019, HBV-related and HCV-related diseases are still associated with a high burden, highlighting the need for more intensive and coordinated interventions within European countries to reach the goal of elimination by 2030.