The three-decade trajectory of hepatitis C burden among women of reproductive age in China: a retrospective and predictive study

BACKGROUND: This study evaluates the changing burden of hepatitis C (HCV) among women of reproductive age (15-49 years) in China from 1990-2021 and forecasts trends to 2035. METHODS: Using data from the Global Burden of Disease 2021 study, we analyzed age-standardized rates (ASRs) for incidence, prevalence, mortality, and disability-adjusted life years (DALYs) related to acute and chronic HCV in this population. Statistical analyses included estimating annual percentage changes (EAPCs), applying Poisson-based age-period-cohort (APC) modeling to assess epidemiological drivers, and employing Bayesian APC modeling for future projections. Decomposition analysis was used to quantify contributions from population growth, aging, and epidemiological factors. RESULTS: From 1990 to 2021, all ASRs for HCV among women of reproductive age in China showed significant declines, with rates of decrease surpassing global averages. Despite this progress, China remained a high-burden country for this group in 2021, with a large reservoir of chronic HCV cases. A notable rebound in the incidence of chronic HCV occurred after 2010. Epidemiological trends displayed clear age stratification: the most substantial improvements were observed in younger cohorts (aged 15-24 years), while older groups (aged 45-49 years) experienced slower declines or recent rebounds in incidence. Decomposition analysis indicated that the reduction in disease burden was primarily driven by epidemiological improvements (e.g., in prevention and treatment), which successfully offset the adverse effects of population growth. This pattern contrasts with the global trend, where increasing burden is largely attributed to demographic factors. Projections suggest a continued decline in ASRs and case numbers through 2035, although the rate of decline is expected to slow. CONCLUSIONS: Historical HCV control measures for women of reproductive age in China have been effective, as evidenced by steep declines in mortality and DALYs. However, persistent challenges include a substantial existing patient pool and a resurgent incidence, particularly among older individuals within this demographic. This study precisely quantifies a successful epidemiological transition and identifies a shift in risk profiles, underscoring the continued need for sustained, age-tailored public health interventions to achieve HCV elimination goals.