Viral Hepatitis Leading Cause of Death Worldwide

Four major hepatitis genotypes kill more people than HIV, malaria, and tuberculosis.

Viral hepatitis was recently found to be the leading cause of death worldwide, killing at least as many people annually as HIV/AIDS, malaria, and tuberculosis (TB).

Over a 23-year period from 1990 to 2013, viral hepatitis deaths increased by 63%, according to a study published in The Lancet. Viral hepatitis deaths were higher in middle- and high-income countries compared with lower-income countries; however, the authors noted that the overall disease burden is now more evenly divided between the lower- and higher-income countries.

“This is the most comprehensive analysis to date of the global burden of viral hepatitis,” said lead researcher Graham Cooke. “And it reveals startling findings, showing the death toll from this condition is now 1.45 million. Whereas death from many infectious diseases, such as TB and malaria, have dropped since 1990, viral hepatitis deaths have risen. Although there are effective treatments and vaccines for viral hepatitis, there is very little money invested in getting these to patients, especially compared to malaria, HIV/AIDS, and TB.

“We now have a viral hepatitis global action plan approved in May by the World Health Assembly, and we now need to implement it.”

For the study, researchers analyzed data between 1990 and 2013 from the Global Burden of Disease study, which included 183 countries. Only deaths from the 4 major genotypes (hepatitis A, B, C, and E) were included in the analysis.

The results showed that deaths from cirrhosis, liver disease, and acute infection caused by viral hepatitis increased from 890,000 in 1990 to 1.45 million in 2013, a 63% jump. In comparison, findings from a 2015 study by the Institute for Health Metrics and Evaluation reported in 2013, there were 1.3 million people worldwide who died from AIDS, 1.4 million from TB, and 855,000 from malaria.

In the current study, researchers found that a majority of hepatitis deaths occurred in East Asia, and the majority of global deaths occurred from hepatitis B and C. Authors noted that a possible reason for the large number of deaths from these forms of the virus is because the strains cause long-term infections that have very few immediate symptoms.

This allows the virus to go unnoticed as it progresses, leading to serious liver damage or cancer.

“Although we have had an effective hepatitis B vaccine for years, there is still a large proportion of the world which is unvaccinated,” Cooke said. “We have no similar vaccine for hepatitis C.”

In addition to the hepatitis deaths, researchers also estimated the years of life lost by subtracting the age of death from the longest possible life expectancy for a person at that age. The results of these calculations showed that the years of life lost in 2013 surpassed 41 million, with more than 870,000 years for people who lived with disabilities related to the virus.

“We explored the relationship between the burden of viral hepatitis and economic status,” Cooke said. “Viral hepatitis has consistently been ranked as a leading cause of mortality in upper-middle income countries, but a relative rise in mortality in lower-middle income countries has been associated with a narrowing in the rankings by 2013. Our results suggest that an evolution in funding structures is required to accommodate viral hepatitis and allow effective responses in low and low-to-middle middle income countries.”

Although there have been some breakthroughs in treating viral hepatitis, there are still limitations to these treatments, the authors noted.

“We have tools at our disposal to treat this disease — we have vaccines to hepatitis A and B, and we have new treatments to C,” Cooke said. “However, the price of new medicines is beyond the reach of any countrym rich or poor. This study will hopefully highlight that we should be doing more to make treatments for viral hepatitis affordable and accessible.”