Hepatitis B and C mortality from 1990 to 2019 in China: a Bayesian age-period-cohort analysis

BACKGROUND: Significant decreases in hepatitis B virus (HBV) and hepatitis C virus (HCV) infections have been observed in China, but both remain leading public health challenges. Estimating the components and trends in HBV and HCV mortality is vital for disease control planning. The current analysis investigated time trends in hepatitis B and C mortality and the relationships with age, period, and birth cohort from 1990 to 2019. We also made projections for 2030–2034 in China. METHODS: Mortality data related to hepatitis B and C were obtained from the Global Burden of Disease (GBD) study, which was stratified by complications, age, sex, and specific geographical locations. An age-period-cohort (APC) analytical framework was adopted to measure age, period, and cohort effects, which fits a log-linear Poisson model over a Lexis diagram of observed rates and quantifies the additive effects of age, period, and birth cohorts. We estimated longitudinal age curves (expected longitudinal age-specific rates), net drift (overall annual percentage change), local drift (annual percentage change in each age group), period, and cohort relative risks. A Bayesian APC analysis was used to project future age-specific hepatitis B and C deaths. RESULTS: In China, the age-standardized mortality rate (ASMR) of hepatitis B and C decreased by 67% and 58% from 1990 to 2019, respectively. The overall annual percentage changes in hepatitis B and C were −4.97% and −6.49% for males and −3.85% and −6.09% for females, respectively. After adjusting for period and cohort effects, we observed an exponential increase in hepatitis C mortality with age, with the Bell-like curves peaking at approximately 50 years old for hepatitis B. The Bayesian APC analysis projected that hepatitis B and C deaths would decrease dramatically by 42% and 22% for the periods 2016–2019 and 2030–2034, respectively. The declines in ASMRs related to hepatitis B and C were associated with the improvements in the Chinese Socio-Demographic Index. CONCLUSIONS: Although the burden of hepatitis B and C mortality is likely to continue declining in China, the hepatitis B and C mortality was still high. Therefore, the national efforts should still be strengthened to achieve the global hepatitis elimination targets.