Burden of liver fibrosis and steatosis coexisting with hepatitis B or C infection in China: a population-based study from the 2020 National Serological Survey

Background The burden of liver fibrosis and steatosis coexisting with hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in China remains to be quantified. Objective To estimate the prevalence of HBV or HCV infection with liver fibrosis and steatosis to inform national elimination strategies. Design This study was conducted among individuals aged 15–69 years in the 2020 National Serological Survey of Viral Hepatitis in China. Among participants with HBV or HCV infection, liver fibrosis and steatosis were assessed using vibration-controlled transient elastography. Weighted prevalence and population estimates of HBV or HCV infection coexisting with liver fibrosis and steatosis were calculated. Results Among 69 351 participants, 4236 had HBV infection and 122 had HCV infection. The weighted population prevalence of HBV and HCV infection with ≥F2 fibrosis was 0.63% (95% CI 0.52% to 0.77%) and 0.05% (95% CI 0.03% to 0.08%), accounting for an estimated 6.08 million and 0.48 million individuals in China, respectively. The corresponding prevalence of steatosis was 1.82% (95% CI 1.56% to 2.13%) and 0.06% (95% CI 0.04% to 0.10%), accounting for an estimated 17.30 million and 0.61 million individuals respectively. Diagnosis rates were 59.78% for HBV infection and 38.02% for HCV infection, and treatment rates were 7.60% and 48.66% respectively. Conclusion China continues to face a substantial burden of advanced liver disease among people with viral hepatitis, further compounded by the high prevalence of liver steatosis. Proactive case-finding and linkage to care are essential to achieving elimination of viral hepatitis as a public health threat.