The Global Burden of Viral Hepatitis 1990-2013

Background: With recent improvements in vaccines and treatments against viral hepatitis, a better understanding of the burden of viral hepatitis is needed to inform global intervention strategies. We present estimates from the Global Burden of Disease (GBD) Study of morbidity and mortality for acute viral hepatitis, and for cirrhosis and liver cancer due to viral hepatitis by age, sex and country for 1990 through 2013. Methods: Mortality was estimated using natural history models for acute hepatitis and GBD’s cause-of-death ensemble model for cirrhosis and liver cancer. We estimated disease prevalence, and liver cancer and cirrhosis aetiologies via meta-regression. Disability adjusted life-years (DALYs) were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs). Findings: Between 1990 and 2013, viral hepatitis deaths increased from 0·90 million (95% uncertainty interval 0·86 – 0·94) to 1·45 million (1·38–1·54); YLLs increased from 31·0 million (29·6–32·6) to 41·6 million (39·1–44·7); YLDs, from 0·65 million (0·45–0·89) to 0·87 million (0·61–1·18); and DALYs, from 31·7 million (30·2– 33·3) to 42·5 million (39·9–45·6). In 2013, viral hepatitis was the 7 leading cause of death globally. Interpretation: Viral hepatitis is a leading cause of death and disability worldwide. Unlike most communicable diseases, between 1990 and 2013, viral hepatitis has increased in terms of both absolute burden and its relative rank. Funding: Bill and Melinda Gates Foundation