Epidemiological trends and projections to 2035 of hepatitis B burden in China, 1990-2021.

BACKGROUND: Hepatitis B virus (HBV) remains a major cause of liver disease and premature death globally, with China bearing a significant share of the burden. However, long-term trends and future projections of HBV burden in China remain insufficiently described, despite widespread infant vaccination and expanded antiviral therapy. METHODS: We analyzed hepatitis B-related mortality, age-standardized mortality rate (ASMR), disability-adjusted life years (DALYs), and age-standardized DALY rate (ASDR) in China from 1990 to 2021 using data extracted from the GBD 2021 database. Temporal trends were quantified by estimated annual percentage change (EAPC). RESULTS: Between 1990 and 2021, the number of deaths from hepatitis B-related liver diseases in China increased from 215 thousand to 219 thousand (+1.83%), whereas the ASMR decreased from 23.86 per 100,000 to 10.68 (EAPC: -2.78). The disability-adjusted life years (DALYs) decreased from 7.78 million in 1990 to 6.61 million in 2021 (-15.04%), with the ASDR decreasing from 774 per 100,000-329 (EAPC: -3). Despite significant reductions in HBV mortality and DALYs, the growing burden of HBV-related liver cancer, particularly among older males, remains a critical concern. Targeted early screening and treatment strategies are urgently needed. Projections for 2035 indicate a continued decline in the overall burden of hepatitis B, with the liver cancer burden showing a fluctuating decrease. CONCLUSION: Despite progress in HBV prevention and control, the increasing burden of hepatitis B-related liver cancer remains a major public health challenge.