Paediatric chronic hepatitis C and the global elimination gap: burden and trends from 1990 to 2023 in the Global Burden of Disease Study 2023.
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BACKGROUND: Paediatric chronic hepatitis C (PCHC) is often asymptomatic and underdiagnosed, and its contemporary global burden remains incompletely characterised. We estimated global, national, and socioeconomic trends in PCHC using Global Burden of Disease (GBD) 2023 estimates, and hepatitis C virus (HCV)-related liver cancer as a limited Supplementary analysis. METHODS: We analysed GBD 2023 estimates of prevalence, mortality, and disability-adjusted life years (DALYs) for PCHC in people younger than 20 years from 1990 to 2023. Results were summarised globally, across seven official GBD super-regions, and for 204 countries and territories using annual point estimates and supplied 95% uncertainty intervals. Because HCV-related liver cancer estimates were unavailable for children younger than 10 years, analyses of this endpoint were restricted to ages 10-19 years. FINDINGS: Global PCHC prevalence was 0.380% (95% uncertainty interval [UI] 0.314-0.452) in 2023, representing a decline from 0.443% (0.376-0.514) in 1990, with an absolute change of -0.062 percentage points and a relative change of -14.1%. Mortality declined from 0.0890 (0.0504-0.1538) to 0.0595 (0.0303-0.1023) deaths per 100,000 population younger than 20 years, and the DALY rate declined from 7.49 (4.36-12.92) to 5.06 (2.62-8.40) per 100,000. The highest prevalences clustered in Central Asia, South-East Asia, and sub-Saharan Africa. INTERPRETATION: The PCHC burden has declined globally, particularly mortality and DALYs, but prevalence has fallen only modestly. The continued high burden in Central Asia, South-East Asia, and sub-Saharan Africa, and marked country heterogeneity highlight the need to integrate antenatal screening, follow-up of perinatally exposed infants, and access to curative treatment for children aged 3 years or older into hepatitis elimination programmes in order to reach the 2030 elimination targets. FUNDING: National Institutes of Health.