Impact of urbanization on morbidity of hepatitis A: a national panel study in China during 2005–2018

Abstract

Background The effect of urbanization on the morbidity of hepatitis A remains unclear. We aimed to estimate the association between various urbanization-related indices and hepatitis A morbidity in China. Methods Data on the annual morbidity of hepatitis A, urbanization-related measures (i.e., gross domestic product per capita, the number of hospitalization beds per 1000 persons, illiteracy rate, tap water coverage, motor vehicles per 100 persons, population density, and the proportion of arable land), and meteorological factors in 31 provincial-level administrative divisions of Chinese mainland during 2005–2018 were collected from the National Population and Health Science Data Sharing Platform, China Statistical Yearbooks, and the China Meteorological Data Sharing Service System, respectively. Generalized linear mixed models were applied to quantify the impacts of different urbanization-related indices on the morbidity of hepatitis A in China after adjusting for covariates. Results A total of 537,466 hepatitis A cases were reported in China during 2005–2018. The annual morbidity had a decline of 79.4% from 5.64 cases to 1.16 cases per 100,000 people. There were obvious spatial variations with higher morbidity in western China. Nationally, gross domestic product per capita and the number of hospitalization beds per 1000 persons increased from 14,040 to 64,644 CNY and from 2.45 to 6.03 during 2005–2018, respectively. The illiteracy rate decreased from 11.0 to 4.9%. Gross domestic product per capita [relative risk (RR) = 0.96, 95% confidence interval (CI): 0.92–0.99], and the number of hospitalization beds per 1000 persons (RR = 0.79, 95% CI: 0.75–0.83) were associated with the declined morbidity of hepatitis A. By contrast, the increased morbidity of hepatitis A was linked to the illiteracy rate (RR = 1.04, 95% CI: 1.02–1.06). Similar influential factors were detected for children and adults, with greater effects witnessed for children. Conclusions People in the western region suffered the heaviest burden of hepatitis A in Chinese mainland. Nationally, there was a sharp decline in the morbidity of hepatitis A. The urbanization process was associated with the reduction of hepatitis A morbidity in China during 2005–2018. Graphical Abstract

Trends of Hepatitis A Virus Infection in Poland: Assessing the Potential Impact of the COVID-19 Pandemic and War in Ukraine

“…Our study also reports that HAV infections were consistently more common in individuals, both women and men, who inhabit urban areas. This is an interesting finding, especially if one considers that some epidemiological studies conducted in other world regions point to the contrary, implying that the urbanization process is generally associated with a reduction in hepatitis A morbidity due to comprehensive improvement in sanitary facilities related to water supply, excrement disposal, and environmental hygiene compared to rural areas [ 39 ]. Conversely, a study in Korea evidenced a higher prevalence of HAV infections in urban areas with a high population density [ 40 ], which is in line with our observations.…”

The Effectiveness of National Expanded Program on Immunization With Hepatitis A Vaccines in the Chinese Mainland: Interrupted Time-Series Analysis

“…Notably, the postintervention incidence of hepatitis A in Western China, especially in Tibet and Xinjiang, was still significantly higher than that of other regions of China, although the EPI had largely alleviated the local burden of hepatitis A. These discrepancies might be related to impoverishment [ 24 ] and the lack of vaccination awareness. For example, the vaccination coverage in children was only about 60% in Tibet in 2004, and about 71% of towns in Xinjiang achieved the goal of 90% coverage of hepatitis A vaccine in 2013 [ 10 , 33 , 34 ].…”

“…Differences in EIRs could be boiled down to 2 reasons, namely, the level of development and the incidence before the implementation of the EPI. The regions where society and economy have forged ahead during the last decade (ie, high GDP per capita, the fast urbanization process, sufficient medical resources, decreased proportion of children, or advanced education level), accompanied by improvements in sanitary and hygienic conditions (ie, sufficient medical resources), are associated with the less exposure to HAV, which could partly explain the regional difference in EIRs [ 24 , 35 ]. More could be credited to the fact that there were lower incidence of hepatitis A and higher seroprevalence of anti-HAV antibody in regions with thriving economy before the intervention [ 11 ].…”

“…The provincial-level annual data (ie, the age-specific resident population, gross domestic product [GDP] per capita, urbanization rates, the number of hospitalization beds per 1000 persons, the proportion of children younger than 14 years old, and illiteracy rates) from 2005 to 2019 were compiled from China Statistical Yearbooks [ 23 , 24 ]. The monthly resident population was derived from linear interpolation.…”

The Effectiveness of National Expanded Program on Immunization With Hepatitis A Vaccines in the Chinese Mainland: Interrupted Time-Series Analysis (Preprint)

“…Differences in EIRs could be boiled down to 2 reasons, namely, the level of development and the incidence before the implementation of the EPI. The regions where society and economy have forged ahead during the last decade (ie, high GDP per capita, the fast urbanization process, sufficient medical resources, decreased proportion of children, or advanced education level), accompanied by improvements in sanitary and hygienic conditions (ie, sufficient medical resources), are associated with the less exposure to HAV, which could partly explain the regional difference in EIRs [24,35].…”