Changing prevalence of chronic hepatitis B virus infection in China between 1973 and 2021: a systematic literature review and meta-analysis of 3740 studies and 231 million people

Abstract

ObjectiveChina concentrates a large part of the global burden of HBV infection, playing a pivotal role in achieving the WHO 2030 global hepatitis elimination target.MethodsWe searched for studies reporting HBV surface antigen (HBsAg) seroprevalence in five databases until January 2023. Eligible data were pooled using a generalised linear mixed model with random effects to obtain summary HBsAg seroprevalence. Linear regression was used to estimate annual percentage change (APC) and HBsAg prevalence in 2021.Results3740 studies, including 231 million subjects, were meta-analysed. HBsAg seroprevalence for the general population decreased from 9.6% (95% CI 8.4 to 10.9%) in 1973–1984 to 3.0% (95% CI 2.1 to 3.9%) in 2021 (APC=−3.77; p<0.0001). Decreases were more pronounced in children <5 years (APC=−7.72; p<0.0001) and 5–18 years (−7.58; p<0.0001), than in people aged 19–59 years (−2.44; p<0.0001), whereas HBsAg seroprevalence increased in persons ≥60 years (2.84; p=0.0007). Significant decreases were observed in all six major Chinese regions, in both men (APC=−3.90; p<0.0001) and women (−1.82; p<0.0001) and in high-risk populations. An estimated 43.3 million (95% uncertainty interval 30.7–55.9) persons remained infected with HBV in China in 2021 (3.0%), with notable heterogeneity by region (<1.5% in North China to>6% in Taiwan and Hong Kong) and age (0.3%, 1.0%, 4.7% and 5.6% for <5 years, 5–18 years, 19–59 years and≥60 years, respectively).ConclusionsChina has experienced remarkable decreases in HBV infection over the last four decades, but variations in HBsAg prevalence persist in subpopulations. Ongoing prevention of HBV transmission is needed to meet HBV elimination targets by 2030.Trial registration numberPROSPERO (CRD42021284217)

Comprehensive approach to controlling chronic hepatitis B in China

“…The prevalence and magnitude of reduction in chronic HBV infection vary by geographical region and across other strata of the Chinese population. In the mainland of China, the highest prevalence in the latest study period was observed in the Xizang Autonomous Administrative Region (formerly known as Tibet), followed by other provinces mostly clustered in southern China (Hainan, Jiangxi, Fujian, Guangxi, Guangdong and Qinghai), whereas the lowest seroprevalence was observed in Beijing and Shanxi [ 53 ]. This geographical heterogeneity in HBsAg prevalence is consistent with that observed in a recently published study among nearly 100 million pregnant women across 31 provinces in China [ 54 ].…”

The Diagnostic Value of Liver Biopsy for Unexplained Liver Dysfunction: A Retrospective Study

“… 4 China has the highest HBV infection burden in Asia, and although the prevalence of HBV in China has decreased in the past 40 years, the prevalence of hepatitis B surface antigen (HBsAg) in some subpopulations is still high in China. 5 Furthermore, intravenous drug users are at relatively high risk of contracting hepatitis C, and those who have been previously infected with this disease but have not been cured account for the majority of existing patients. 6 China is a high epidemic area for viral hepatitis.…”

Quantitative Measurement of Serum HBcrAg Can Be Used to Assess the Feasibility of Safe Discontinuation of Antiviral Therapy for Chronic Hepatitis B

“…The research report by Polaris Observatory Collaborators indicates that the global HBV prevalence in 2022 is estimated to be 3.2%, corresponding to 257.5 million HBsAg-positive individuals [ 2 ]. In China, the prevalence of HBsAg among the general population in 2021 was 3%, and the estimated chronic HBV infection was 43.3 million [ 3 ]. China accounts for a significant portion of the global burden of HBV infections and plays a key role in achieving the World Health Organization’s 2030 global hepatitis elimination target [ 3 ].…”

“…In China, the prevalence of HBsAg among the general population in 2021 was 3%, and the estimated chronic HBV infection was 43.3 million [ 3 ]. China accounts for a significant portion of the global burden of HBV infections and plays a key role in achieving the World Health Organization’s 2030 global hepatitis elimination target [ 3 ]. The persistent presence of covalently closed circular DNA (cccDNA) in hepatocytes is a key obstacle for a cure of chronic hepatitis B (CHB) [ 4 ].…”