The global burden of viral hepatitis: better estimates to guide hepatitis elimination eff orts

1030 www.thelancet.com Vol 388 September 10, 2016 A recurring question about viral hepatitis is why it receives so little funding and attention from global health policy makers and donors. For example, the Sustainable Development Goals have a goal to “end the epidemics of” HIV, tuberculosis, and malaria by 2030 while only “combating” hepatitis, despite the fact that hepatitis accounts for more deaths than each of those infections individually. One reason for this is the diffi culty in accurately quantifying and explaining the morbidity and mortality related to viral hepatitis. This diffi culty stems from the fact that hepatitis deaths are caused by fi ve distinct viruses (hepatitis A–E) with diff erent routes of transmission, that death occurs decades after infection, and that when people die with hepatitis-related liver cancer and cirrhosis, these deaths are not always linked to the underlying infection. In The Lancet, Jeff rey Stanaway and colleagues have made a major advance in addressing these challenges. Using the Global Burden of Disease (GBD) Study approach, which estimates the causes of mortality and morbidity and their relative importance, they have assessed the burden of disease caused by viral hepatitis from 1990 to 2013 at the country, regional, and global levels. The main conclusion from their analysis is that viral hepatitis accounted for 1·45 million deaths (95% uncertainty interval [UI] 1·38–1·54) in 2013, a 63% (95% UI 52–75) increase compared with the 0·89 million deaths (0·86–0·94) in 1990. Morbidity also increased in terms of years lived with disability (from 0·65 million [0·45–0·89] to 0·87 million [0·61–1·18]) and disability-adjusted life-years (DALYs; from 31·7 million [30·2–33·3] to 42·5 million [39·9–45·6]). The biggest increase was noted for hepatitis C infection, for which the rate of DALYs increased by 43%. Most The global burden of viral hepatitis: better estimates to guide hepatitis elimination eff orts balloon assisted maturation is not done in these centres. However, the low patency rate does raise the question of whether the benefi t of BPB would still be evident at higher patency rates. The study results seem to suggest that sympathetic blockade with BPB is of sustained benefi t in patients undergoing radiocephalic fi stula formation, and both surgeons and anaesthetists should consider its use in this group of patients.