Trends and cross-country inequalities in the global burden of acute hepatitis A : a systematic analysis study

Abstract Background: Conducting a global epidemiological assessment is imperative for devising effective prevention and control strategies against Acute Hepatitis A (AHA). This investigation systematically assessed the worldwide, regional, and national disease burden of AHA. Methods:​ Utilizing comprehensive datasets from the Global Burden of Disease Study 1990–2021, we evaluated temporal trends in AHA incidence and disability-adjusted life years (DALYs) through jointpoint regression, decomposition analysis, health inequality metrics, and Bayesian forecasting models. Results:​ In 2021, global AHA incidence and DALYs totaled 1.61 billion cases and 1.82 million, respectively. Age-standardized rates per 100,000 population reached 2,273.72 for incidence and 24.95 for DALYs. India manifested the highest absolute burden, whereas Afghanistan and Somalia exhibited the most elevated age-standardized rates. Globally, incidence and DALYs demonstrated overall declines from 1990 to 2021, with DALYs diminishing more precipitously; trends diverged substantially across Socio-demographic Index (SDI) quintiles. Decomposition analysis identified population growth and shifting epidemiological patterns as primary drivers of DALY trajectories, while successful disease-control initiatives substantially mitigated population-driven burden escalation. Cross-national health equity evaluations revealed disproportionately high burdens in low-SDI nations, though disparities are progressively narrowing. Projections to 2030 anticipate continued reductions in age-standardized incidence rates, case counts, and DALYs, portending favorable control trajectories. Conclusions:​ Substantial strides in AHA control have been achieved over the past three decades, attributable to vaccination programs and sanitation policies. Future success necessitates evidence-based, multi-pronged countermeasures integrating prevention and clinical interventions to realize the global imperative of viral hepatitis elimination.