Global, regional, and national burden of chronic hepatitis C including cirrhosis from 1990 to 2021, alongside projections for the next 15 years

Chronic hepatitis C (CHC), including cirrhosis, remains a major global health challenge. While direct-acting antivirals have improved prognoses, barriers to diagnosis and equitable access hinder World Health Organization's 2030 eradication target. This study systematically assessed the global burden and trends to inform prevention strategies. Based on the Global Burden of Disease Study 2021 database, this analysis quantified the absolute numbers and age-standardized rates (ASRs) of 4 disease burden indicators, including incidence, prevalence, deaths, and disability-adjusted life years (DALYs), for CHC, including cirrhosis, across global, regional, and national levels from 1990 to 2021. Temporal trends were quantified using the estimated annual percent change and Joinpoint regression. Decomposition, health inequality, and frontier analyses were used to characterize drivers and socioeconomic gradients, with Bayesian age-period-cohort projections to 2036. Analyses were stratified by socio-demographic index (SDI), sex, and age. In 2021, the global numbers of incidence, prevalence, deaths, and DALYs for CHC, including cirrhosis, were substantially higher than in 1990, though the ASRs declined. Significant socioeconomic inequalities persisted, with the highest burden in low SDI regions. South Asia, Southeast Asia, East Asia, Western Sub-Saharan Africa, and North Africa and the Middle East showed the highest absolute numbers for disease burden indicators; Sub-Saharan Africa, Central Asia, Southeast Asia, and North Africa and the Middle East had the highest ASRs. Males exhibited higher deaths and DALYs than females. Decomposition analysis identified population growth and aging as drivers of increased disease burden, partially countered by epidemiological improvements. Frontier analysis revealed substantial unrealized potential in low SDI settings. Projections indicated a continued decline in ASRs, but the number of prevalence may reach approximately 150 million by 2036 under the continuation of current trends. Despite declining ASRs of CHC, including cirrhosis, from 1990 to 2021, the absolute burden increased due to demographic shifts. Pronounced socioeconomic inequalities persist, with the highest burden concentrated in low SDI regions.