S2127 The Global Burden of Hepatitis C Virus in Young and Middle-Aged Adults From 1990 to 2020

Introduction: Hepatitis C virus (HCV) remains a significant health concern and a major contributor to global chronic liver diseases and hepatocellular carcinoma. According to the World Health Organization, it is estimated that 50 million individuals worldwide are chronically infected with HCV despite the recent advancement in its treatment regimens. The aim of this study was to evaluate trends in HCV-related burden globally with stratification by sex and Socio-demographic Index (SDI). Methods: Global data were extracted from the Global Burden of Disease (GBD) database for individuals aged 15-49 years from 1990 to 2021. The primary outcomes included incidence, mortality, and disability-adjusted life years (DALYs) per 100,000 population. Data were stratified by sex and SDI and reported with 95% confidence intervals (CIs). Results: Between 1990 and 2021, global HCV incidence remained stable, from 83.94 per 100,000 (CI: 58.73-112.44) to 83.28 (CI: 58.97-113.22). Males had higher incidence than females, with rates of 86.61 (CI: 60.82-115.43) vs 81.19 (CI: 56.77-109.50) in 1990 and 88.33 (CI: 62.74-119.18) vs 78.09 (CI: 54.82-106.71) in 2021. Mortality declined globally from 3.13 (CI: 2.50-3.89) per 100,000 in 1990 to 2.70 (CI: 2.18-3.29) per 100,000 in 2021. Males had significantly higher mortality than females: 4.28 (CI: 3.37-5.49) vs 1.95 (CI: 1.54-2.38) per 100,000 in 1990, and 3.71 (CI: 2.95-4.57) vs 1.67 (CI: 1.34-2.03) per 100,000 in 2021. Low-middle SDI regions had the highest mortality with rate of 3.2 per 100,000 by 2021, while high SDI regions maintained the lowest with rate of 1.8 per 100,000 in 2021. DALY rates declined globally from 161.08 (CI: 127.94-201.50) to 137.63 (CI: 111.51-168.31), with males again disproportionately affected: 218.34 (CI: 172.72-280.19) vs 102.29 (CI: 80.65-124.70) in 1990, and 187.70 (CI: 149.64-232.42) vs 86.25 (CI: 69.73-105.44) in 2021. High-middle SDI regions experienced the highest DALY burden of 180 per 100,000 in 2021. Conclusion: In the young age group (15-49), HCV incidence remained largely unchanged from 1990 to 2021, the observed decline in mortality and DALYs which suggests meaningful progress in disease management, particularly through the introduction of effective antiviral therapies. However, the consistent burden among males and the disproportionately higher impact in low- and middle-SDI regions reveal ongoing disparities in prevention, diagnosis, and treatment access. Sustained global efforts are essential to close these gaps, improve health equity, and advance toward HCV elimination goals.