Research in context
Evidence before this study
On Oct 5, 2015, we searched PubMed for ““Hepatitis, Viral, Human”[Mesh] AND (burden OR DALY OR QALY OR HALE OR YLL OR YLD)”, with no restrictions on language or date of publication, and found 1445 publications. We excluded any studies that did not report original estimates of the frequency or burden of disease related to hepatitis A, B, C, or E infection, any studies that were restricted to special subpopulations (eg, injection drug users and people living with HIV), and any studies that did not produce estimates for an area larger than a country. 20 articles met our search criteria: two studies of hepatitis A virus seroprevalence; three studies of hepatitis B virus (HBV) seroprevalence; 12 studies of hepatitis C virus (HCV) that reported estimates of seroprevalence, prevalence of viraemia, incidence, or mortality; one study of hepatitis E virus (HEV) incidence and mortality; one study reporting estimates of cirrhosis and liver cancer due to HBV and HCV; and one study of liver cancer due to HBV and HCV. We found no studies that reported original estimates of the total burden of viral hepatitis, and no studies reporting global estimates of a comprehensive health gap metric (ie, disability-adjusted life-years or quality-adjusted life-years) for any of the four hepatitis viruses.
Added value of this study
We used data from the Global Burden of Disease (GBD) Study to estimate morbidity and mortality for acute viral hepatitis, and for cirrhosis and liver cancer due to HBV and HCV, by age group, sex, and country from 1990 to 2013. Although sequela-specific hepatitis burden estimates have been published previously, our study is the first formal attempt to estimate the total burden of viral hepatitis, using systematic data gathering and robust statistical methods, and the trends in that burden over time. To our knowledge, this study is the first to explore the drivers of change in the burden of hepatitis and the effect of hepatitis in different country income levels. The effect of viral hepatitis has not been clearly recognised in previous GBD reports because estimates for acute disease, cirrhosis, and liver cancer have been reported separately. This paper is the first to place the burden of viral hepatitis in the context of overall global health.
Implications of all the available evidence
Our results show that viral hepatitis is one of the leading causes of death and disability worldwide, and causes at least as many deaths annually as tuberculosis, AIDS, or malaria. By contrast with most other communicable diseases, hepatitis has risen in importance since the first GBD Study in 1990. As WHO launches a major new effort to tackle viral hepatitis, these data are of crucial importance to global health policy.