Hepatitis B burden in the Middle East and North Africa region, 1990–2030: trends, projections, and age–period–cohort analysis

Hepatitis B virus (HBV) infection remains a significant public health issue in the Middle East and North Africa (MENA) region, where disparities in healthcare infrastructure, ongoing conflicts, and suboptimal vaccination coverage hinder elimination efforts. This ecological study aimed to assess the temporal trends and age-period-cohort (APC) effects on the HBV-related disease burden across 21 MENA countries (Afghanistan, Algeria, Bahrain, Egypt, Iraq, the Islamic Republic of Iran, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Palestine, Qatar, Saudi Arabia, Sudan, the Syrian Arab Republic (SAR), Tunisia, Türkiye, the United Arab Emirates (UAE), and Yemen) from 1990 to 2021 and to forecast future incidence and mortality trends through 2030. Data on incidence, mortality, and disability-adjusted life years (DALYs) were retrieved from the Global Burden of Disease database. Age-standardized incidence rates (ASIRs) and mortality rates (ASMRs) were analyzed by sociodemographic index (SDI) group. APC analysis and autoregressive integrated moving average (ARIMA) models were applied. From 1990 to 2021, new HBV cases increased by 2.8%, deaths increased by 17.8%, and DALYs increased by 11.6%. APC analysis shows a marked decline in HBV-related rate ratios across periods and birth cohorts. The most pronounced reductions were observed in younger birth cohorts and in the post-2015 period, while the burden remained noticeably persistent in older birth cohorts. ARIMA-based projections indicate that by 2030, the ASIR and ASMR are expected to decline by 34.6% and 41.8%, respectively, falling short of the WHO’s 2030 elimination benchmarks. These findings underscore the critical need to strengthen timely birth-dose and childhood hepatitis B vaccination across the MENA region, together with expanding population-based screening and treatment services and enhancing surveillance systems. In addition, given the substantial heterogeneity in socioeconomic conditions, health-system capacity, and HBV epidemiology across MENA countries, tailored and country-specific strategies are essential. Such context-adapted approaches will be crucial for accelerating progress toward HBV elimination and achieving the WHO 2030 targets.