- Incidence and prevalence
We used over 110,000 outcomes of incidence, prevalence, YLD, YLL and DALYs for hepatitis and the following three levels: 29 age groups; 33 provinces/regions; and 7 individual years from 1990 to 2016.
From 1990 to 2016, the incidence of hepatitis in China (counts in thousands) decreased by 88.5%, from 117,492 (95% UI: 66,517-151,302) to 13502 (95% UI: 10,918-15,967), and age-standardized incidence rates per 100,000 decreased by 87.1% from 10,114 (95% UI: 5,734-12,988) to 1,305 (95% UI: 950-1,549). However, the prevalence of hepatitis in China (counts in thousands) increased by 37.6%, from 153,856 (95% UI: 136,047-172,319) in 1990 to 211,721 (95% UI: 179,776-240,981) in 2016, and age-standardized prevalence rates per 100,000 changed slightly by -3.3%, from 13,537 (95% UI: 12,075-15,156) to 13,089 (95% UI: 11,882-15,760) (Table 1).
Among the four kinds of hepatitis, the incidence and prevalence of acute hepatitis A and acute hepatitis E, along with the age-standardized rates, all decreased dramatically. The case numbers and age-standardized rates of prevalence increased by 35.9% and 1.6% for hepatitis B, respectively, and by 81.8% and 30.4% for hepatitis C.
In 2016, Guangdong province ranked first among the 33 provinces/regions of China in the number of newly infected hepatitis patients with 1,170,000 counts. Tibet, Qinghai and Gansu had the highest age-standardized incidence rates at >2,000/100,000 people; Tibet had the highest of all at 12,563/100,000. Guangxi, Guangdong and Hainan had the highest age-standardized prevalence rates at >16,500/100,000, whereas Beijing, Hong Kong and Macao had the lowest age-standardized incidence rate and prevalence rate (Table 2).
Among the four kinds of viral hepatitis, the incidence rates for acute hepatitis A, hepatitis B, and acute hepatitis E decreased dramatically over the last few decades, especially acute hepatitis A and hepatitis B (Fig.1). However, the age-standardized prevalence rate for hepatitis B decreased slightly from 1990 to 2000 then increased from 2005 and sustained a high level in the past ten years.
The incidence rates and prevalence rates of the four kinds of hepatitis by sex and age group in 2016 are presented in Fig.2. The low age group (<5 year) had the highest incidence rate. For example, the incidence rate of acute hepatitis A was 5,733/100,000 for males and 6,381/100,000 for females and the incidence rate of acute hepatitis C was 815/100,000 for males and 884/100,000 for females. In most of the age groups, the incidence rates in males were higher than those in females. The prevalence rates slightly increased starting from the <5 year age group and then sharply increased at 15-49 year age group. The prevalence rates for males and females stabilized starting from the 50-69 year age group.
- DALYs
The DALYs for hepatitis decreased by 78.5%, from 1403,788 (95% UI: 1,319,601-1507,691) in 1990 to 302,026 (95% UI: 287,096-319,734) in 2016. In 2016, the DALYs for acute hepatitis A, hepatitis B, hepatitis C and acute hepatitis E were 14.1, 263.6, 4.1 and 20.2 (in thousands), respectively. The overall age-standardized DALY rate decreased by 85.5% from 135.2 (95% UI: 127.2-1145.0) to 19.6 (95% UI: 18.6-20.8) per 100,000 (Table 1).
Provincial-level DALYs and age-standardized rates of DALYs per 100,000 in 1990 and 2016 are also shown in Table 2. In 2016, the top three provinces with the heaviest disease burden caused by viral hepatitis were Hunan, Guangdong and Sichuan, with the number of DALYs >21,000. Tibet, Qinghai and Gansu had the highest age-standardized DALY rates at >40/100,000 people. However, Hong Kong, Beijing, and Tianjin had the lowest age-standardized DALY rates.
DALYs number and DALY rates in 2016 by sex and age group are shown in Table 3 and Fig.3. In the <5 year age group, the burden of disease was mainly caused by acute hepatitis A, with the number of DALYs and age-standardized DALY rate of 8,673 (95% UI: 7320-10839) and 14.3 (95% UI: 12.1-17.9)/100,000, respectively. The overall number of DALYs for viral hepatitis gradually increased starting from the 5-14 year age group and peaked at the 50-69 year age group for male and ≧70 year age group for female. The DALY rates in males were higher than those in females except that in <5 year age group.
According to the SDI value in 2016, the 33 provinces were classified into three groups. The mean number of DALYs for hepatitis B in 2016 was 5,970 for the high-middle SDI region, 8,533 for the middle SDI region, and 7,828 for the low-middle SDI region. The age-standardized DALY rates for hepatitis of the four aetiologies all decreased dramatically after 2000. In 2016, the age-standardized DALY rates for hepatitis B were approximately 9.1/100,000 for high-middle SDI level regions, 17.4/100,000 for middle SDI level regions and 56.4/100,000 for low-middle SDI level regions (Table. 4). There was a moderate negative correlation between SDI and DALYs (rs=-0.808, P<0.001).