The Lancet Gastroenterology & Hepatology ( IF 35.7 ) Pub Date : 2022-06-21 , DOI: 10.1016/s2468-1253(22)00124-8 Brittney S Sheena , Lindsey Hiebert , Hannah Han , Helen Ippolito , Mohsen Abbasi-Kangevari , Zeinab Abbasi-Kangevari , Hedayat Abbastabar , Amir Abdoli , Hiwa Abubaker Ali , Mesafint Molla Adane , Oyelola A Adegboye , Qorinah Estiningtyas Sakilah Adnani , Shailesh M Advani , Muhammad Sohail Afzal , Saira Afzal , Mohamad Aghaie Meybodi , Bahman Ahadinezhad , Bright Opoku Ahinkorah , Sajjad Ahmad , Tauseef Ahmad , Sepideh Ahmadi , Haroon Ahmed , Muktar Beshir Ahmed , Tarik Ahmed Rashid , Gizachew Taddesse Akalu , Addis Aklilu , Tayyaba Akram , Hanadi Al Hamad , Fares Alahdab , Adugnaw Zeleke Alem , Dejene Tsegaye Alem , Fadwa Alhalaiqa Naji Alhalaiqa , Robert Kaba Alhassan , Liaqat Ali , Muhammad Ashar Ali , Yousef Alimohamadi , Vahid Alipour , Motasem Alkhayyat , Sami Almustanyir , Rajaa M Al-Raddadi , Haya Altawalah , Saeed Amini , Hubert Amu , Robert Ancuceanu , Catalina Liliana Andrei , Tudorel Andrei , Amir Anoushiravani , Adnan Ansar , Anayochukwu Edward Anyasodor , Jalal Arabloo , Morteza Arab-Zozani , Ayele Mamo Argaw , Zeleke Gebru Argaw , Muhammad Arshad , Anton A Artamonov , Tahira Ashraf , Daniel Atlaw , Floriane Ausloos , Marcel Ausloos , Sina Azadnajafabad , Mohammadreza Azangou-Khyavy , Amirhossein Azari Jafari , Ghasem Azarian , Sayna Bagheri , Saeed Bahadory , Atif Amin Baig , Maciej Banach , Nastaran Barati , Amadou Barrow , Abdul-Monim Mohammad Batiha , Diana Fernanda Bejarano Ramirez , Uzma Iqbal Belgaumi , Alemshet Yirga Berhie , Devidas S Bhagat , Nikha Bhardwaj , Pankaj Bhardwaj , Krittika Bhattacharyya , Vijayalakshmi S Bhojaraja , Ali Bijani , Antonio Biondi , Belay Boda Abule Bodicha , Hunduma Amensisa Bojia , Archith Boloor , Cristina Bosetti , Dejana Braithwaite , Nikolay Ivanovich Briko , Zahid A Butt , Luis Alberto Cámera , Raja Chandra Chakinala , Promit Ananyo Chakraborty , Jaykaran Charan , Shu Chen , Jee-Young Jasmine Choi , Sonali Gajanan Choudhari , Fazle Rabbi Chowdhury , Dinh-Toi Chu , Sheng-Chia Chung , Paolo Angelo Cortesi , Benjamin C Cowie , Garland T Culbreth , Omid Dadras , Xiaochen Dai , Lalit Dandona , Rakhi Dandona , Fernando Pio De la Hoz , Sisay Abebe Debela , Mohammed Gebre Dedefo , Feleke Mekonnen Demeke , Takele Gezahegn G Demie , Getu Debalkie Demissie , Meseret Derbew Molla , Abebaw Alemayehu Desta , Deepak Dhamnetiya , Mandira Lamichhane Dhimal , Meghnath Dhimal , Mojtaba Didehdar , Linh Phuong Doan , Fariba Dorostkar , Thomas M Drake , Fatemeh Eghbalian , Michael Ekholuenetale , Iman El Sayed , Maysaa El Sayed Zaki , Muhammed Elhadi , Mohamed A Elmonem , Aisha Elsharkawy , Shymaa Enany , Daniel Berhanie Enyew , Ryenchindorj Erkhembayar , Sharareh Eskandarieh , Firooz Esmaeilzadeh , Sayeh Ezzikouri , Hossein Farrokhpour , Getahun Fetensa , Florian Fischer , Masoud Foroutan , Mohamed M Gad , Abhay Motiramji Gaidhane , Shilpa Gaidhane , Natalie C Galles , Silvano Gallus , Teferi Gebru Gebremeskel , Eyob Alemayehu Gebreyohannes , Keyghobad Ghadiri , Kazem Ghaffari , Mansour Ghafourifard , Seyyed-Hadi Ghamari , Ahmad Ghashghaee , Ali Gholami , Abdolmajid Gholizadeh , Aima Gilani , Amit Goel , Mahaveer Golechha , Pouya Goleij , Davide Golinelli , Giuseppe Gorini , Yitayal Ayalew Goshu , Max G Griswold , Mohammed Ibrahim Mohialdeen Gubari , Bhawna Gupta , Sapna Gupta , Veer Bala Gupta , Vivek Kumar Gupta , Rasool Haddadi , Rabih Halwani , Saeed S Hamid , Samer Hamidi , Asif Hanif , Shafiul Haque , Harapan Harapan , Arief Hargono , Sanam Hariri , Ahmed I Hasaballah , S M Mahmudul Hasan , Soheil Hassanipour , Hadi Hassankhani , Simon I Hay , Khezar Hayat , Golnaz Heidari , Claudiu Herteliu , Demisu Zenbaba Heyi , Kamal Hezam , Ramesh Holla , Mohammad-Salar Hosseini , Mostafa Hosseini , Mehdi Hosseinzadeh , Mihaela Hostiuc , Mowafa Househ , Junjie Huang , Nawfal R Hussein , Ivo Iavicoli , Segun Emmanuel Ibitoye , Olayinka Stephen Ilesanmi , Irena M Ilic , Milena D Ilic , Lalu Muhammad Irham , Jessica Y Islam , Nahlah Elkudssiah Ismail , Kathryn H Jacobsen , Farhad Jadidi-Niaragh , Amirreza Javadi Mamaghani , Shubha Jayaram , Ranil Jayawardena , Rime Jebai , Ravi Prakash Jha , Nitin Joseph , Farahnaz Joukar , Billingsley Kaambwa , Ali Kabir , Zubair Kabir , Rohollah Kalhor , Himal Kandel , Tesfaye K Tesfaye Kanko , Rami S Kantar , Ibraheem M Karaye , Bekalu Getnet Kassa , Phillip M Kemp Bohan , Mohammad Keykhaei , Yousef Saleh Khader , Himanshu Khajuria , Gulfaraz Khan , Imteyaz A Khan , Junaid Khan , Moien AB Khan , Javad Khanali , Amir M Khater , Mahalaqua Nazli Khatib , Mahmoud Khodadost , Abdullah T Khoja , Omid Khosravizadeh , Jagdish Khubchandani , Gyu Ri Kim , Hanna Kim , Min Seo Kim , Yun Jin Kim , Jonathan M Kocarnik , Ali-Asghar Kolahi , Rajasekaran Koteeswaran , G Anil Kumar , Carlo La Vecchia , Dharmesh Kumar Lal , Iván Landires , Savita Lasrado , Jeffrey V Lazarus , Caterina Ledda , Doo Woong Lee , Sang-woong Lee , Yeong Yeh Lee , Miriam Levi , Jiarui Li , Stephen S Lim , Stany W Lobo , Platon D Lopukhov , Joana A Loureiro , Jennifer H MacLachlan , Hassan Magdy Abd El Razek , Muhammed Magdy Abd El Razek , Azeem Majeed , Alaa Makki , Mohammad-Reza Malekpour , Reza Malekzadeh , Ahmad Azam Malik , Fariborz Mansour-Ghanaei , Mohammad Ali Mansournia , Francisco Rogerlândio Martins-Melo , Philippa C Matthews , Walter Mendoza , Ritesh G Menezes , Tuomo J Meretoja , Amanual Getnet Mersha , Tomislav Mestrovic , Ted R Miller , Le Huu Nhat Minh , Andreea Mirica , Seyyedmohammadsadeq Mirmoeeni , Erkin M Mirrakhimov , Sanjeev Misra , Prasanna Mithra , Babak Moazen , Ashraf Mohamadkhani , Mokhtar Mohammadi , Shafiu Mohammed , Nagabhishek Moka , Ali H Mokdad , Jalal Moludi , Sara Momtazmanesh , Lorenzo Monasta , Ghobad Moradi , Maliheh Moradzadeh , Rahmatollah Moradzadeh , Paula Moraga , Ebrahim Mostafavi , Sumaira Mubarik , Malaisamy Muniyandi , Christopher J L Murray , Mohsen Naghavi , Mukhammad David Naimzada , Sreenivas Narasimha Swamy , Zuhair S Natto , Biswa Prakash Nayak , Javad Nazari , Ionut Negoi , Serban Mircea Negru , Seyed Aria Nejadghaderi , Sandhya Neupane Kandel , Huong Lan Thi Nguyen , Che Henry Ngwa , Robina Khan Niazi , Chukwudi A Nnaji , Jean Jacques Noubiap , Ali Nowroozi , Virginia Nuñez-Samudio , Bogdan Oancea , Chimedsuren Ochir , Oluwakemi Ololade Odukoya , In-Hwan Oh , Andrew T Olagunju , Babayemi Oluwaseun Olakunde , Ahmed Omar Bali , Emad Omer , Stanislav S Otstavnov , Bilcha Oumer , Jagadish Rao Padubidri , Adrian Pana , Anamika Pandey , Eun-Cheol Park , Fatemeh Pashazadeh Kan , Urvish K Patel , Uttam Paudel , Ionela-Roxana Petcu , Zahra Zahid Piracha , Richard Charles G Pollok , Maarten J Postma , Akram Pourshams , Hossein Poustchi , Mohammad Rabiee , Navid Rabiee , Alireza Rafiei , Sima Rafiei , Pavan Manibettu Raghuram , Mosiur Rahman , Amir Masoud Rahmani , Setyaningrum Rahmawaty , Aashish Rajesh , Priyanga Ranasinghe , Chythra R Rao , Sowmya J Rao , Mahsa Rashidi , Mohammad-Mahdi Rashidi , David Laith Rawaf , Salman Rawaf , Reza Rawassizadeh , Negar Rezaei , Aziz Rezapour , Sahba Rezazadeh-Khadem , Jefferson Antonio Buendia Rodriguez , Godfrey M Rwegerera , Siamak Sabour , Basema Saddik , Mohammad Reza Saeb , Umar Saeed , Amirhossein Sahebkar , KM Saif-Ur-Rahman , Sarvenaz Salahi , Hamideh Salimzadeh , Chethan Sampath , Abdallah M Samy , Juan Sanabria , Francesco Sanmarchi , Milena M Santric-Milicevic , Arash Sarveazad , Brijesh Sathian , Monika Sawhney , Abdul-Aziz Seidu , Sadaf G Sepanlou , Allen Seylani , Saeed Shahabi , Masood Ali Shaikh , Elaheh Shaker , Murad Ziyaudinovich Shakhmardanov , Mohammed Shannawaz , Suchitra M Shenoy , Jeevan K Shetty , Pavanchand H Shetty , Kenji Shibuya , Jae Il Shin , Parnian Shobeiri , Migbar Mekonnen Sibhat , Achintya Dinesh Singh , Jasvinder A Singh , Surjit Singh , Valentin Yurievich Skryabin , Anna Aleksandrovna Skryabina , Amir Ali Sohrabpour , Suhang Song , Seidamir Pasha Tabaeian , Eyayou Girma Tadesse , Majid Taheri , Mircea Tampa , Ker-Kan Tan , Ahmad Tavakoli , Abdelghani Tbakhi , Belay Negash Tefera , Arash Tehrani-Banihashemi , Habtamu Molla Tesfaw , Rekha Thapar , Aravind Thavamani , Seyed Abolfazl Tohidast , Daniel Nigusse Tollosa , Maria Elena Tosti , Marcos Roberto Tovani-Palone , Eugenio Traini , Mai Thi Ngoc Tran , Indang Trihandini , Biruk Shalmeno Tusa , Irfan Ullah , Marco Vacante , Sahel Valadan Tahbaz , Pascual R Valdez , Shoban Babu Varthya , Bay Vo , Yasir Waheed , Adisu Birhanu Weldesenbet , Melat Woldemariam , Suowen Xu , Seyed Hossein Yahyazadeh Jabbari , Mehdi Yaseri , Yigizie Yeshaw , Vahit Yiğit , Birhanu Wubale Yirdaw , Naohiro Yonemoto , Chuanhua Yu , Ismaeel Yunusa , Mazyar Zahir , Leila Zaki , Mohammad Zamani , Maryam Zamanian , Mikhail Sergeevich Zastrozhin , Theo Vos , John W Ward , M Ashworth Dirac
Background
Combating viral hepatitis is part of the UN Sustainable Development Goals (SDGs), and WHO has put forth hepatitis B elimination targets in its Global Health Sector Strategy on Viral Hepatitis (WHO-GHSS) and Interim Guidance for Country Validation of Viral Hepatitis Elimination (WHO Interim Guidance). We estimated the global, regional, and national prevalence of hepatitis B virus (HBV), as well as mortality and disability-adjusted life-years (DALYs) due to HBV, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. This included estimates for 194 WHO member states, for which we compared our estimates to WHO elimination targets.
Methods
The primary data sources were population-based serosurveys, claims and hospital discharges, cancer registries, vital registration systems, and published case series. We estimated chronic HBV infection and the burden of HBV-related diseases, defined as an aggregate of cirrhosis due to hepatitis B, liver cancer due to hepatitis B, and acute hepatitis B. We used DisMod-MR 2.1, a Bayesian mixed-effects meta-regression tool, to estimate the prevalence of chronic HBV infection, cirrhosis, and aetiological proportions of cirrhosis. We used mortality-to-incidence ratios modelled with spatiotemporal Gaussian process regression to estimate the incidence of liver cancer. We used the Cause of Death Ensemble modelling (CODEm) model, a tool that selects models and covariates on the basis of out-of-sample performance, to estimate mortality due to cirrhosis, liver cancer, and acute hepatitis B.
Findings
In 2019, the estimated global, all-age prevalence of chronic HBV infection was 4·1% (95% uncertainty interval [UI] 3·7 to 4·5), corresponding to 316 million (284 to 351) infected people. There was a 31·3% (29·0 to 33·9) decline in all-age prevalence between 1990 and 2019, with a more marked decline of 76·8% (76·2 to 77·5) in prevalence in children younger than 5 years. HBV-related diseases resulted in 555 000 global deaths (487 000 to 630 000) in 2019. The number of HBV-related deaths increased between 1990 and 2019 (by 5·9% [–5·6 to 19·2]) and between 2015 and 2019 (by 2·9% [–5·9 to 11·3]). By contrast, all-age and age-standardised death rates due to HBV-related diseases decreased during these periods. We compared estimates for 2019 in 194 WHO locations to WHO-GHSS 2020 targets, and found that four countries achieved a 10% reduction in deaths, 15 countries achieved a 30% reduction in new cases, and 147 countries achieved a 1% prevalence in children younger than 5 years. As of 2019, 68 of 194 countries had already achieved the 2030 target proposed in WHO Interim Guidance of an all-age HBV-related death rate of four per 100 000.
Interpretation
The prevalence of chronic HBV infection declined over time, particularly in children younger than 5 years, since the introduction of hepatitis B vaccination. HBV-related death rates also decreased, but HBV-related death counts increased as a result of population growth, ageing, and cohort effects. By 2019, many countries had met the interim seroprevalence target for children younger than 5 years, but few countries had met the WHO-GHSS interim targets for deaths and new cases. Progress according to all indicators must be accelerated to meet 2030 targets, and there are marked disparities in burden and progress across the world. HBV interventions, such as vaccination, testing, and treatment, must be strategically supported and scaled up to achieve elimination.
Funding
Bill & Melinda Gates Foundation.
中文翻译：
1990-2019 年全球、区域和国家乙型肝炎负担：2019 年全球疾病负担研究的系统分析
背景
抗击病毒性肝炎是联合国可持续发展目标 (SDG) 的一部分，世卫组织已在其全球卫生部门病毒性肝炎战略 (WHO-GHSS) 和病毒性肝炎消除国家验证临时指南 (WHO) 中提出了消除乙型肝炎的目标临时指南）。作为全球疾病、伤害和风险因素负担的一部分，我们估算了乙型肝炎病毒 (HBV) 的全球、区域和国家流行情况，以及由 HBV 引起的死亡率和伤残调整生命年 (DALYs)研究 (GBD) 2019。这包括对 194 个 WHO 成员国的估计，我们将我们的估计与 WHO 消除目标进行了比较。
方法
主要数据来源是基于人口的血清学调查、索赔和出院、癌症登记、生命登记系统和已发表的病例系列。我们估计了慢性 HBV 感染和 HBV 相关疾病的负担，定义为乙型肝炎引起的肝硬化、乙型肝炎引起的肝癌和急性乙型肝炎的总和。我们使用了 DisMod-MR 2.1，一种贝叶斯混合效应元数据- 回归工具，用于估计慢性 HBV 感染、肝硬化的患病率和肝硬化的病因学比例。我们使用时空高斯过程回归建模的死亡率与发病率比率来估计肝癌的发病率。我们使用了死亡原因集成建模 (CODEm) 模型，这是一种根据样本外性能选择模型和协变量的工具，用于估计肝硬化导致的死亡率，
发现
2019 年，估计全球所有年龄段的慢性 HBV 感染患病率为 4·1%（95% 不确定区间 [UI] 3·7 至 4·5），相当于 3.16 亿（284 至 351）感染者。1990 年至 2019 年间，全年龄段患病率下降了 31·3%（29·0 至 33·9），儿童患病率下降更为显着，为 76·8%（76·2 至 77·5） 5岁以下。2019 年，HBV 相关疾病导致全球 555 000 人死亡（487 000 至 630 000 人）。1990 年至 2019 年间，HBV 相关死亡人数增加了（增加了 5·9% [–5·6 至 19·2]）和2015 年至 2019 年（2·9% [–5·9 至 11·3]）。相比之下，HBV 相关疾病导致的全年龄和年龄标准化死亡率在此期间有所下降。我们将 194 个 WHO 地点 2019 年的估计值与 WHO-GHSS 2020 目标进行了比较，发现四个国家的死亡人数减少了 10%，15 个国家的新病例减少了 30%，147 个国家的 5 岁以下儿童患病率达到 1%。截至 2019 年，194 个国家中有 68 个已经实现了世卫组织临时指南中提出的 2030 年目标，即所有年龄段的 HBV 相关死亡率为每 10 万人中有 4 人。
解释
自引入乙型肝炎疫苗接种以来，慢性 HBV 感染的流行率随着时间的推移而下降，尤其是在 5 岁以下的儿童中。HBV 相关死亡率也有所下降，但由于人口增长、老龄化和队列效应，HBV 相关死亡人数有所增加。到 2019 年，许多国家已经达到了 5 岁以下儿童的中期血清阳性率目标，但很少有国家达到了 WHO-GHSS 的死亡和新病例中期目标。必须加快所有指标的进展以实现 2030 年目标，并且世界各地的负担和进展存在显着差异。必须从战略上支持和扩大 HBV 干预措施，例如疫苗接种、检测和治疗，以实现消除。
资金
比尔和梅琳达·盖茨基金会。
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