S2357 The Burden of Hepatitis B Between 2001 and 2021 in the United States by Region

Introduction: Hepatitis B (HBV) remains an important cause of morbidity and mortality globally and in the United States. However, the landscape of HBV management and prevention has changed with introduction of new antivirals and recombinant vaccines. National and regional trends in HBV-related disease in the U.S. have yet to be fully described. This study focuses on the U.S. burden of HBV due to acute hepatitis, chronic disease, and liver cancer. Methods: Data were obtained from the publicly available Global Burden of Disease Study 2021. We examined total burden of HBV, as well as burden due to acute HBV, chronic disease/cirrhosis, and liver cancer. Incidence, Disability-Adjusted Life Years (DALYs), and death rates, all per 100,000, were age adjusted using the U.S. 2000 standard population. Data were further stratified by state and grouped based on U.S. census regions (midwest, northeast, south, and west) and analyzed using one-way ANOVAs with Tukey’s HSD for post-hoc testing. Results: In 2021, the age-adjusted rate of incidence, DALYs, and deaths attributed to HBV in the U.S. was 86.4, 44.67, and 1.46 per 100,000, respectively. From 2001 to 2021, the age-adjusted rate for incidence decreased by 39% (CI 34.5 – 43.8), DALYs remained similar at 4.9% (CI -0.5 – 11.5), and deaths increased by 10.8% (CI 5.0 – 16.8). The rate of age-adjusted DALYs for acute hepatitis decreased by 0.6 cases per 100,000 (CI 0.57 - 0.68) but increased for liver cancer by 2.45 cases per 100,000 (CI 1.2 – 3.9). Statistically significant regional differences were found in 2021 for age-adjusted rates of incidence (P < 0.001), DALYs (P < 0.001) and deaths (P < 0.001) attributed to HBV. The west region had the highest rates in all 3 measures. Similar trends were seen with acute HBV rates of incidence (P < 0.001), DALYs (P < 0.001), and deaths (P = 0.002). Regional variation also was seen in chronic disease incidence (P < 0.001) and liver cancer incidence (P = 0.01). There were no significant differences in changes in rate between regions during the study period for incidence, DALYs, or deaths attributed to HBV, except for a significant change in incidence of acute infection, with the south seeing the largest decrease in rate. Conclusion: Between 2001 and 2021 in the U.S., the burden of acute HBV infection decreased while the burden due to liver cancer attributed to HBV increased. As we strive for WHO and White House’s viral hepatitis elimination goal, it is critical to further characterize regional and demographic variations in HBV burden.