Background and purpose

Despite decades of improved sanitation and hygiene measures and vaccine introduction, hepatitis A has been spread through numerous outbreaks globally. We used data from the Global Burden of Disease (GBD) study to quantify hepatitis A burden at the global, regional and national levels.

Methods

Annual incident cases, deaths, age-standardized incidence rates (ASIRs), and age-standardized mortality rates (ASMRs) of hepatitis A between 1990 and 2019 were derived from the GBD study 2019. Percentage changes of cases and deaths, and estimated annual percentage changes (EAPCs) of ASIRs and ASMRs were calculated to quantify their temporal trends.

Results

Global hepatitis A incident cases increased by 13.90% from 139.54 million in 1990 to 158.94 million in 2019. ASIR of hepatitis A remained stable (EAPC = 0.00, 95% CI −0.01 to 0.01), whereas ASMR decreased (EAPC = −4.63, 95% CI −4.94 to −4.32) between 1990 and 2019. ASIR increased in low (EAPC = 0.09, 95% CI 0.04 to 0.14) and low-middle (EAPC = 0.04, 95% CI 0.03 to 0.06) socio-demographic index (SDI) regions. For GBD regions, the most significant increases of ASIR were detected in high-income Asia Pacific (EAPC = 0.53, 95% CI 0.41 to 0.66), Oceania (EAPC = 0.31, 95% CI 0.25 to 0.36), and Australasia (EAPC = 0.28, 95% CI 0.13 to 0.44). EAPC of ASIR was positively associated with SDI value in countries and territories with SDI value ≥ 0.7 (ρ = −0.310, p < 0.001).

Conclusion

There is an unfavorable trend that hepatitis A is still pending in hyperendemic regions and is emerging in low endemic regions. These highlight the need of targeted and specific strategies to eliminate hepatitis A, such as sanitation measures and a comprehensive plan for surveillance and vaccination against hepatitis A.

中文翻译：

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1990-2019年甲型肝炎发病率和死亡率的全球趋势和区域差异及其预防意义

背景和目的

尽管几十年来改善了环境卫生和个人卫生措施并引入了疫苗，但甲型肝炎已通过全球多次爆发传播。我们使用来自全球疾病负担 (GBD) 研究的数据来量化全球、区域和国家层面的甲型肝炎负担。

方法

1990 年至 2019 年间甲型肝炎的年度发病病例、死亡、年龄标准化发病率 (ASIR) 和年龄标准化死亡率 (ASMR) 来自 GBD 研究 2019。病例和死亡的百分比变化，以及估计的年度百分比计算 ASIR 和 ASMR 的变化（EAPC）以量化它们的时间趋势。

结果

全球甲型肝炎发病病例从 1990 年的 1.3954 亿增加到 2019 年的 1.5894 亿，增加了 13.90%。甲型肝炎的 ASIR 保持稳定（EAPC = 0.00, 95% CI -0.01 至 0.01），而 ASMR 下降（EAPC = -4.63, 95 % CI -4.94 至 -4.32）在 1990 年至 2019 年间。ASIR 在低（EAPC = 0.09，95% CI 0.04 至 0.14）和中低（EAPC = 0.04，95% CI 0.03 至 0.06）社会人口学指数（ SDI) 地区。对于 GBD 地区，在高收入亚太地区（EAPC = 0.53, 95% CI 0.41 至 0.66）、大洋洲（EAPC = 0.31, 95% CI 0.25 至 0.36）和大洋洲（EAPC = 0.28, 95% CI 0.13 至 0.44)。在 SDI 值≥ 0.7 的国家和地区，ASIR 的 EAPC 与 SDI 值呈正相关（ρ  = -0.310，p  < 0.001）。

结论

有一个不利的趋势是甲型肝炎在高流行地区仍处于未决状态，而在低流行地区正在出现。这些强调需要有针对性和具体的战略来消除甲型肝炎，例如卫生措施和针对甲型肝炎的监测和疫苗接种的综合计划。