Sensitivity Analysis of Hepatitis B and C Mortality in England Using Data Linkage: Meeting the <scp>WHO</scp> Elimination Threshold for Mortality

The United Kingdom, along with many other countries, is working towards eliminating viral hepatitis as a public health threat by 2030, with a combined mortality target of less than or equal to six deaths per 100,000 population. The current methodology of reporting uses death registrations alone, which has been estimated to underestimate mortality rates by up to 60% for hepatitis C (HCV)-related liver disease. We aim to conduct a sensitivity analysis using data linkage of death certificates, hepatitis B (HBV) and HCV diagnoses and admissions for end-stage liver disease (ESLD) and/or hepatocellular carcinoma (HCC) to estimate mortality rates, assess progress towards elimination and evaluate underreporting. Between 2000 and 2023, 7967 deaths were reported due to HBV- and/or HCV-associated ESLD and/or HCC. Using data linkage of all three datasets, this increased to 11,487, with underreporting estimated to be 37% overall. The upper bound combined mortality rate was estimated to be 1.3 deaths per 100,000 population at its peak in 2015, therefore surpassing the WHO target for all years evaluated. From 2015 to 2023, both HCV-associated ESLD and/or HCC mortality decreased (1.12 to 0.88 deaths per 100,000 population), however, there was a slight increase for HBV-associated ESLD and/or HCC deaths during the same time frame (0.3 to 0.35). A higher proportion of HBV-related deaths were in males (p < 0.05) who died outside London (p < 0.05) and a lower proportion were White (p < 0.05) when compared to HCV-related deaths. While England has met the WHO impact targets, it is important we continue to drive reductions in mortality.