Global burden, trends and inequalities of hepatitis B among women of childbearing age, 1990-2021.

BACKGROUND: Women of childbearing age (WCBA) are a key group for hepatitis B virus (HBV) infection elimination and maternal health. We aimed to investigate global patterns, trends and inequalities in the burden of HBV among WCBA based on the Global Burden of Disease 2021 database. METHODS: We extracted data on the prevalence of chronic HBV infection and HBV-related mortality among WCBA in 204 countries and territories from 1990 to 2021. The estimated annual percentage change (EAPC) was calculated to quantify the temporal trends in age-standardized prevalence (ASPR) and mortality rate (ASMR). Inequalities across countries in chronic HBV infection and HBV-related deaths were measured using the concentration index. RESULTS: In 2021, the global ASPR per 100,000 population of chronic HBV infection among WCBA was 3664, corresponding to 71.4 million infected people. From 1990 to 2021, the global ASPR declined annually by 1.2%, while prevalence rates remained relatively high in Central and Western Africa. HBV-related ASMR declined worldwide (EAPC = -1.49%, 95% CI: -1.55, -1.42), whereas upward trends were observed in the United Kingdom (EAPC = 1.79, 95% CI: 1.41, 2.18) and Poland (EAPC = 1.29, 95% CI: 0.89, 1.69). Both the number of chronic HBV infection cases and HBV-related deaths in low socio-demographic index (SDI) region showed an increasing trend. SDI-related inequality in chronic HBV infection increased from 1990 to 2021, except in high-income countries, Latin America and the Caribbean. CONCLUSIONS: The global prevalence of chronic HBV infection among WCBA declined over time, but low SDI countries remained a region of concern. Furthermore, the concentration of HBV disease burden among disadvantaged populations requires targeted interventions.