title: The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013.
abstract: With recent improvements in vaccines and treatments against viral hepatitis, an improved understanding of the burden of viral hepatitis is needed to inform global intervention strategies. We used data from the Global Burden of Disease (GBD) Study to estimate morbidity and mortality for acute viral hepatitis, and for cirrhosis and liver cancer caused by viral hepatitis, by age, sex, and country from 1990 to 2013.
  
  
  
  We estimated mortality using natural history models for acute hepatitis infections and GBD's cause-of-death ensemble model for cirrhosis and liver cancer. We used meta-regression to estimate total cirrhosis and total liver cancer prevalence, as well as the proportion of cirrhosis and liver cancer attributable to each cause. We then estimated cause-specific prevalence as the product of the total prevalence and the proportion attributable to a specific cause. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs).
  
  
  
  Between 1990 and 2013, global viral hepatitis deaths increased from 0·89 million (95% uncertainty interval [UI] 0·86-0·94) to 1·45 million (1·38-1·54); YLLs from 31·0 million (29·6-32·6) to 41·6 million (39·1-44·7); YLDs from 0·65 million (0·45-0·89) to 0·87 million (0·61-1·18); and DALYs from 31·7 million (30·2-33·3) to 42·5 million (39·9-45·6). In 2013, viral hepatitis was the seventh (95% UI seventh to eighth) leading cause of death worldwide, compared with tenth (tenth to 12th) in 1990.
  
  
  
  Viral hepatitis is a leading cause of death and disability worldwide. Unlike most communicable diseases, the absolute burden and relative rank of viral hepatitis increased between 1990 and 2013. The enormous health loss attributable to viral hepatitis, and the availability of effective vaccines and treatments, suggests an important opportunity to improve public health.
  
  
  
  Bill & Melinda Gates Foundation.
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA. Electronic address: stanaway@uw.edu.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Stanaway
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Abraham D
authors.initials: AD
authors.lastname: Flaxman
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Naghavi
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Division of Hematology, Department of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Fitzmaurice
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Theo
authors.initials: T
authors.lastname: Vos
authors.affiliation: Institute for Global Health, University College London, London, UK.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Abubakar
authors.affiliation: Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar.
authors.forename: Laith J
authors.initials: LJ
authors.lastname: Abu-Raddad
authors.affiliation: Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Assadi
authors.affiliation: Queen Elizabeth Hospital Birmingham, Birmingham, UK; University of Otago Medical School, Wellington, New Zealand.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Bhala
authors.affiliation: WHO Collaborating Centre for Viral Hepatitis, Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC, Australia; Doherty Institute, University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Cowie
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Forouzanfour
authors.affiliation: Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
authors.forename: Justina
authors.initials: J
authors.lastname: Groeger
authors.affiliation: Centre for Biomedical Research, Burnet Institute, Melbourne, VIC, Australia; School of Biological Sciences, Universiti Sains Malaysia, Penang, Malaysia.
authors.forename: Khayriyyah Mohd
authors.initials: KM
authors.lastname: Hanafiah
authors.affiliation: Department of Global and Community Health, George Mason University, Fairfax, VA, USA.
authors.forename: Kathryn H
authors.initials: KH
authors.lastname: Jacobsen
authors.affiliation: Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, USA.
authors.forename: Spencer L
authors.initials: SL
authors.lastname: James
authors.affiliation: WHO Collaborating Centre for Viral Hepatitis, Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC, Australia; Doherty Institute, University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: MacLachlan
authors.affiliation: Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Malekzadeh
authors.affiliation: Division of Global Public Health, University of California San Diego, San Diego, CA, USA; School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Natasha K
authors.initials: NK
authors.lastname: Martin
authors.affiliation: Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Ali A
authors.initials: AA
authors.lastname: Mokdad
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Ali H
authors.initials: AH
authors.lastname: Mokdad
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Christopher J L
authors.initials: CJL
authors.lastname: Murray
authors.affiliation: Section Exposure Assessment and Environmental Health Indicators, Federal Environmental Agency, Berlin, Germany.
authors.forename: Dietrich
authors.initials: D
authors.lastname: Plass
authors.affiliation: Contech School of Public Health, Lahore, Pakistan; Contech International Health Consultants, Lahore, Pakistan.
authors.forename: Saleem
authors.initials: S
authors.lastname: Rana
authors.affiliation: NORC at the University of Chicago, Chicago, IL, USA.
authors.forename: David B
authors.initials: DB
authors.lastname: Rein
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
authors.forename: Jan Hendrik
authors.initials: JH
authors.lastname: Richardus
authors.affiliation: Case Western Reserve University, Cleveland, OH, USA; Cancer Treatment Centers of America, Rosalind Franklin University Chicago Medical School, North Chicago, IL, USA.
authors.forename: Juan
authors.initials: J
authors.lastname: Sanabria
authors.affiliation: Bayer AG Turkey, Fatih Sultan Mehmet Mah Balkan Cad, Istanbul, Turkey.
authors.forename: Mete
authors.initials: M
authors.lastname: Saylan
authors.affiliation: Tufts Medical Center, Boston, MA, USA.
authors.forename: Saeid
authors.initials: S
authors.lastname: Shahraz
authors.affiliation: Asian Liver Center, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: So
authors.affiliation: National Research University Higher School of Economics, Moscow, Russia.
authors.forename: Vasiliy V
authors.initials: VV
authors.lastname: Vlassov
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Department of Research, Cancer Registry of Norway, Oslo, Norway; Department of Community Medicine, Faculty of Health Sciences, University of Tromsø-The Arctic University of Norway, Tromsø, Norway; Genetic Epidemiology Group, Folkhälsan Research Center, University of Helsinki, Helsinki, Finland.
authors.forename: Elisabete
authors.initials: E
authors.lastname: Weiderpass
authors.affiliation: US Centers for Disease Control and Prevention, Kampala, Uganda.
authors.forename: Steven T
authors.initials: ST
authors.lastname: Wiersma
authors.affiliation: Jackson State University, Jackson, MS, USA.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Younis
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, and Global Health Institute, Wuhan University, Wuhan, Hubei, China.
authors.forename: Chuanhua
authors.initials: C
authors.lastname: Yu
authors.affiliation: Faculty of Medicine, Mansoura University, Mansoura, Egypt.
authors.forename: Maysaa
authors.initials: M
authors.lastname: El Sayed Zaki
authors.affiliation: Division of Infectious Diseases, Imperial College, London, UK. Electronic address: g.cooke@imperial.ac.uk.
authors.forename: Graham S
authors.initials: GS
authors.lastname: Cooke
mesh_terms: D017281:Cost of Illness; D006233:Persons with Disabilities; D014943:Global Health; D006505:Hepatitis; D006801:Humans; D008017:Life Expectancy; D009017:Morbidity; D019057:Quality-Adjusted Life Years