Challenges in the post-high vaccination coverage era: prevalence characteristics, future projections, and comprehensive management strategies based on risk factor control for chronic hepatitis B in China

Abstract Objective To analyze the epidemiological trends and disease burden in chronic hepatitis B (including cirrhosis) from 1990 to 2021 globally and in China based on Global Burden of Disease Database (GBD) 2021 study, assess development-related inequality patterns and demographic drivers, and project China’s future burden and risk-factor contributions. Methods A secondary analysis was conducted on GBD 2021 data for 1990—2021 to extract the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), and age-standardized disability-adjusted life-year rate (ASDR) globally (204 countries/territories) and in China, each with 95% uncertainty interval (UI). Joinpoint regression was used to estimate the average annual percent change (AAPC) with 95% confidence interval (CI). Combining sociodemographic index (SDI)-related inequality metrics, frontier analysis, and Das Gupta symmetric decomposition, differences in disease burden were quantified, and the relative contributions of population growth, population aging, and changes in age-specific rates to changes in absolute burden were also analyzed. Autoregressive integrated moving average (ARIMA) models were fitted to China’s annual series for 1990—2021 to forecast trends for 2022—2035. Within the GBD comparative risk assessment framework, the attributable burden from alcohol consumption and drug use were quantified. Results Global ASIR, ASPR and ASDR in chronic hepatitis B were declined overall from 1990 to 2021 (all AAPCs, P