Sex-specific burdens of acute hepatitis B and C and their attributable risk factors in 204 countries and territories, 1990–2021

Acute hepatitis B (AHB) and acute hepatitis C (AHC) remain major global health challenges despite the World Health Assembly’s 2030 elimination goals. In addition, the COVID-19 pandemic has disrupted hepatitis control efforts, and sex-specific differences in disease burden remain underexplored. This study aimed to systematically quantify the temporal, geographic, age-, and sex-specific burden of AHB and AHC, as well as the contribution of drug use to disease burden at the global, regional, and national levels. Using data from the Global Burden of Disease Study 2021, we analyzed prevalence, mortality, and disability-adjusted life years (DALYs) for AHB and AHC across 204 countries and 21 regions from 1990 to 2021, with a focus on age, sex, and drug-use-related risk factors. In 2021, global AHB and AHC cases reached 7.3 million and 0.8 million, representing respective declines of 40.2% and 10.7% since 1990. Despite overall reductions, significant regional and sex disparities persist. Males exhibited consistently higher burdens, influenced by biological and behavioral factors. The proportion of DALYs attributable to drug use increased for both infections, especially for AHC. Unexpectedly, South Asia showed rising AHB-related DALYs despite socioeconomic improvement. Although the global burden of AHB and AHC has declined, persistent disparities highlight the need for tailored, virus-specific strategies. Expanding vaccination, screening, antiviral access, and harm-reduction programs is crucial to achieving viral hepatitis elimination by 2030.