The hepatitis B epidemic in China should receive more attention

BackgroundThe Sustainable Development Goals (SDGs), adopted by all United Nations (UN) member states in 2015, established a set of bold and ambitious health-related targets to achieve by 2030. Understanding China’s progress toward these targets is critical to improving population health for its 1.4 billion people.Methods and findingsWe used estimates from the Global Burden of Disease (GBD) Study 2016, national surveys and surveillance data from China, and qualitative data. Twenty-eight of the 37 indicators included in the GBD Study 2016 were analyzed. We developed an attainment index of health-related SDGs, a scale of 0–100 based on the values of indicators. The projection model is adjusted based on the one developed by the GBD Study 2016 SDG collaborators.We found that China has achieved several health-related SDG targets, including decreasing neonatal and under-5 mortality rates and the maternal mortality ratios and reducing wasting and stunting for children. However, China may only achieve 12 out of the 28 health-related SDG targets by 2030. The number of target indicators achieved varies among provinces and municipalities. In 2016, among the seven measured health domains, China performed best in child nutrition and maternal and child health and reproductive health, with the attainment index scores of 93.0 and 91.8, respectively, followed by noncommunicable diseases (NCDs) (69.4), road injuries (63.6), infectious diseases (63.0), environmental health (62.9), and universal health coverage (UHC) (54.4). There are daunting challenges to achieve the targets for child overweight, infectious diseases, NCD risk factors, and environmental exposure factors. China will also have a formidable challenge in achieving UHC, particularly in ensuring access to essential healthcare for all and providing adequate financial protection. The attainment index of child nutrition is projected to drop to 80.5 by 2025 because of worsening child overweight. The index of NCD risk factors is projected to drop to 38.8 by 2025. Regional disparities are substantial, with eastern provinces generally performing better than central and western provinces. Sex disparities are clear, with men at higher risk of excess mortality than women. The primary limitations of this study are the limited data availability and quality for several indicators and the adoption of "business-as-usual" projection methods.ConclusionThe study found that China has made good progress in improving population health, but challenges lie ahead. China has substantially improved the health of children and women and will continue to make good progress, although geographic disparities remain a great challenge. Meanwhile, China faced challenges in NCDs, mental health, and some infectious diseases. Poor control of health risk factors and worsening environmental threats have posed difficulties in further health improvement. Meanwhile, an inefficient health system is a barrier to tackling these challenges among such a rapidly aging population. The eastern provinces are predicted to pe...

Hepatitis B virus (HBV) is a human hepatotropic virus. However, HBV infection also occurs at extrahepatic sites, but the relevant host factors required for HBV infection in non‐hepatic cells are only partially understood. In this article, a non‐hepatic cell culture model is constructed by exogenous expression of four host genes (NTCP, HNF4α, RXRα and PPARα) in human non‐hepatic 293T cells. This cell culture model supports HBV entry, transcription and replication, as evidenced by the detection of HBV pgRNA, HBV cccDNA, HBsAg, HBeAg, HBcAg and HBVDNA. Our results suggest that the above cellular factors may play a key role in HBV infection of non‐hepatic cells. This model will facilitate the identification of host genes that support extrahepatic HBV infection.

Background: The long-term safety of anti-hepatitis B virus (HBV) therapies is critical to assess, particularly in the context of aging chronic hepatitis B (CHB) populations and accumulating comorbidities. HBV is common and clinically consequential in China; however, the demographics and comorbidity burden of this population have not been fully characterized.Aim: To characterize changes in demographics and comorbidity burden of urban Chinese patients with CHB between 2013 and 2016. Methods: The China Health Insurance Research Association (CHIRA) annual urban health insurance claims database from 2013 and 2016 was used to identify adults with ≥1 ICD-10 code for CHB. Descriptive analyses were conducted to compare age and comorbidities distributions between 2013 and 2016.Results: Median age increased from 40 in 2013 (N=14,545) to 44 in 2016 (N=11,648) (P<0.001). The proportion of patients aged >45 years increased significantly from 40.3% in 2013 to 49% in 2016 (P<0.001). Significant increases in multiple comorbidities were observed, including hypertension (9.4% to 14.5%), hyperlipidemia (4.7% to 7.0%), and cardiovascular disease (5.7% to 10%) (P<0.001 for all comparisons). Increases were also observed in renal impairment (8.8% to 10.0%; P<0.001) and osteoporosis and/or pathologic nontraumatic bone fracture (3.8% to 7.3%; P<0.001). Conclusions: Even over the short interval assessed in this study, there was a significant shift in the characteristics of urban CHB patients in China. Aging of the population was accompanied by significant increases in the percentage of patients having potentially concerning comorbidities. Careful selection of treatment options and comorbidity monitoring should be considered when managing Chinese patients with CHB.