P1774 - Global Trends in the Incidence of Hepatitis B Virus and Hepatitis C Virus-Related Cirrhosis and Hepatocellular Carcinoma From 2010 to 2019

Nicolette Veracruz, ¹, Ramsey Cheung, MD², Robert G. Gish, MD³, Robert Wong, MD, MS, FACG^4
1Central Michigan University College of Medicine, Saginaw, MI; ²VA Palo Alto HCS, Palo Alto, CA; ³University of Nevada School of Medicine, La Jolla, CA; ⁴Stanford University School of Medicine/Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA

Introduction: Hepatitis B virus (HBV) and hepatitis C virus (HCV) contribute to significant healthcare burden globally. Improvements in screening, vaccination, and antiviral therapies have led to declines in HBV and HCV related morbidity. We aim to evaluate global trends in HBV and HCV related incidence of acute infections, cirrhosis, and hepatocellular carcinoma (HCC) using a global disease database.

Methods: Using the 2010-2019 Global Burden of Diseases, Injuries, and Risk Factors Study database, incidence rates were calculated for adults with HBV or HCV related acute infection, cirrhosis, and HCC. Disease incidence was presented as age-standardized rates per 100,000 population, and were stratified by age and sex. Comparisons of incidence rates between groups utilized the z-statistic.

Results: From 2010 to 2019, significant declines in disease incidence were observed for acute HBV (-19.3%, 95% CI -32.0 to -4.1, p< 0.05) and HBV cirrhosis (-15.0%, 95% CI -20.7 to -9.8, p< 0.05), whereas incidence of HCV cirrhosis increased 5.6% (95% CI 0.3-10.2, p< 0.05). Both men and women experienced significant declines in incidence of acute HBV and HBV cirrhosis (Table). When stratified by age, adults age 25-49y and 50-69y had significant declines in HBV cirrhosis incidence, and adults age 50-69y had significant declines in HCV-HCC. In 2019, compared to women, men had significantly higher incidence of acute HBV (1,217 vs. 787 per 100,000; p=0.03), HBV cirrhosis (6.3 vs 3.5 per 100,000; p=0.02), HBV-HCC (4.5 vs. 0.9 per 100,000; p< 0.01), HCV cirrhosis (8.2 vs. 5.1 per 100,000; p=0.03), and HCV-HCC (2.3 vs. 1.6 per 100,000; p< 0.01). Among adults with HBV in 2019, patients age 25-49y had the highest incidence of acute HBV (1,569 per 100,000; 95% CI 1180-2070) and HBV cirrhosis (10.6 per 100,000; 95% CI 6.8-15.3), whereas the age >70y group had the highest incidence of HBV-HCC (10.7 per 100,000; 95% CI 8.7-13.2). Among those with HCV in 2019, adults age >70y had the highest incidence of acute HCV (103 per 100,000; 95% CI 70-152) and HCV-HCC (18.3 per 100,000; 95% CI 15.3-21.3), whereas the age 25-49y group had highest incidence of HCV cirrhosis (14.3 per 100,000; 95% CI 9.9-19.9).

Discussion: While overall global incidence of acute HBV and HBV cirrhosis are declining, the rising incidence of HCV cirrhosis is concerning. While the major burden of HBV and HCV related HCC is seen among the oldest age group, the significantly higher incidence of HBV and HCV cirrhosis in the youngest age group is alarming.

	Acute HBV	HBV Cirrhosis	HBV-HCC	Acute HCV	HCV Cirrhosis	HCV-HCC
	Percent Change in Incidence from 2010-2019 (95% CI)	Percent Change in Incidence from 2010-2019 (95% CI)	Percent Change in Incidence from 2010-2019 (95% CI)	Percent Change in Incidence from 2010-2019 (95% CI)	Percent Change in Incidence from 2010-2019 (95% CI)	Percent Change in Incidence from 2010-2019 (95% CI)
Total	-19.3% (-32.0 - -4.1)*	-15.0% (-20.7 - -9.8)*	1.9% (-12.3 - 18.5)	1.2% (0.0 - 2.6)	5.6% (0.3 - 10.2)*	-5.3% (-11.7 - -1.8)
Male	-20.5% (-37.2 - -0.2)*	-17.4% (-23.1 - -11.8)*	1.4% (-15.2 - 20.9)	-1.7% (-3.2 - -0.1)*	3.0% (-2.7 - 7.6)	-6.9% (-14.8 - 2.0)
Female	-21.4% (-37.9 - -0.8)	-15.6% (-21.7 - -9.9)*	-7.3% (-18.9 - 5.7)	0.1% (-1.5 - 1.8)	4.3% (-0.9 - 8.8)	-7.1% (-14.7 - 1.2)
Age 25 to 49 years	-13.5% (-34.7 - 13.4)	-19.1% (-26.2 - -13.0)*	-4.1% (-19.8 - 15.9)	-1.3% (-5.0 - 1.8)	-0.4% (-6.5 - 4.7)	-8.3% (-17.6 - 2.2)
Age 50 to 69 years	-9.9% (-36.0 - 25.1)	-15.1% (-25.2 - -6.4)*	1.4% (-13.2 - 18.5)	-1.8% (-5.5 - 0.8)	8.5% (-1.5 - 15.7)	-9.6% (-17.2 - -1.2)
Age > 70 years	-12.8% (-39.4 - 26.7)	-3.8% (-33.2 - 47.9)	-1.5% (-11.9 - 10.1)	-3.8% (-6.6 - -0.9)*	12.5% (-27.1 - 68.9)	-4.7% (-10.9 - 2.2)

Table: Percent Change in HBV and HCV Incidence from 2010 to 2019 (* p < 0.05)


Disclosures:
Nicolette Veracruz indicated no relevant financial relationships.
Ramsey Cheung indicated no relevant financial relationships.
Robert Gish: Abbott – Consultant. AbbVie – Consultant, Speaker's Bureau. Antios – Consultant. Arrowhead – Advisory Committee/Board Member, Consultant. Bristol Myers – Consultant, Speaker's Bureau. Dova – Consultant. Dynavax – Consultant. Eiger – Advisory Committee/Board Member, Consultant, Stockholder/Ownership Interest (excluding diversified mutual funds). Eisai – Consultant. Enyo – Advisory Committee/Board Member, Consultant. Fujifilm/Wako – Consultant. Genentech – Consultant. Genlantis – Consultant, Stockholder/Ownership Interest (excluding diversified mutual funds). Gilead – Advisory Committee/Board Member, Consultant, Grant/Research Support, Speaker's Bureau. GLG – Consultant. HepaTX – Consultant. HepQuant – Advisory Committee/Board Member, Consultant, Stockholder/Ownership Interest (excluding diversified mutual funds). Intercept – Advisory Committee/Board Member, Consultant, Speaker's Bureau. Janssen – Advisory Committee/Board Member, Consultant. Lilly – Consultant. Merck – Advisory Committee/Board Member, Consultant. Salix – Consultant. Shionogi – Consultant. Viking – Consultant.
Robert Wong: Gilead Sciences – Advisory Committee/Board Member, Consultant, Grant/Research Support.


Nicolette Veracruz, ¹, Ramsey Cheung, MD², Robert G. Gish, MD³, Robert Wong, MD, MS, FACG⁴. P1774 - Global Trends in the Incidence of Hepatitis B Virus and Hepatitis C Virus-Related Cirrhosis and Hepatocellular Carcinoma From 2010 to 2019, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.