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Meta-Analysis
. 2023 Nov 24;72(12):2354-2363.
doi: 10.1136/gutjnl-2023-330691.

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

Zhenqiu Liu  1   2 , Chunqing Lin  3 , Xianhua Mao  4 , Chengnan Guo  5   6 , Chen Suo  2   5   6 , Dongliang Zhu  5 , Wei Jiang  1 , Yi Li  5 , Jiahui Fan  1 , Ci Song  7 , Tiejun Zhang  2   5   6 , Li Jin  1   2 , Catherine De Martel  8 , Gary M Clifford  9 , Xingdong Chen  10   2   11   12
Affiliations
Meta-Analysis

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

Zhenqiu Liu et al. Gut. .

Abstract

Objective: China concentrates a large part of the global burden of HBV infection, playing a pivotal role in achieving the WHO 2030 global hepatitis elimination target.

Methods: We 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.

Results: 3740 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).

Conclusions: China 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 number: PROSPERO (CRD42021284217).

Keywords: HEPATITIS B; META-ANALYSIS.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
The seroprevalence of hepatitis B surface antigen (HBsAg) at the provincial level by study period.
Figure 2
Figure 2
Temporal trends of hepatitis B surface antigen (HBsAg) seroprevalence among the general population in China between 1973 and 2021. (A) Pooled estimates of HBsAg seroprevalence by 2-year study intervals. Studies conducted before year 1984 were compiled due to small sample size and data sparsity. The error bar denotes the 95% CI. (B) Average annual percentage change (APC) of HBsAg seroprevalence. The blue line denotes the fitted values of the linear regression model, in which HBsAg prevalence was regressed on year of study and the log-transformed sample size was used as the weight. The grey shadows denoted the 95% CI of the fitted values. The points denoting prevalence estimate of each included study were not shown due to high overlaps.
Figure 3
Figure 3
The temporal trend of hepatitis B surface antigen (HBsAg) seroprevalence among the general population in China by gender. The blue lines denote the fitted values of the linear regression model, in which HBsAg prevalence was regressed on year of study and the log-transformed sample size was used as the weight. The grey shadows denoted the 95% CIs of the fitted values. The points denoting prevalence estimate of each included study were not shown due to high overlaps. APC, annual percentage change.
Figure 4
Figure 4
The temporal trend of hepatitis B surface antigen (HBsAg) seroprevalence among the general population in China by age. The blue lines denote the fitted values of the linear regression model, in which HBsAg prevalence was regressed on year of study and the log-transformed sample size was used as the weight. The grey shadows denoted the 95% CIs of the fitted values. The points denoting prevalence estimate of each included study were not shown due to high overlaps.APC, annual percentage change.
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