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We conducted a comprehensive assessment of hepatitis A incidence across 204 countries and regions from 1990 to 2021. Annual incident cases and age\u2010standardized incidence rates (ASIR) of hepatitis A were obtained from the Global Burden of Disease (GBD) study 2021. Joinpoint regression analysis evaluated long\u2010term trends in ASIR, while Age\u2010Period\u2010Cohort (APC) analysis assessed the independent effects of age, period, and cohort. Decomposition analysis determined the drivers behind temporal changes in disease incidence. The Slope Index of Inequality (SII) and Concentration Index (CI) were employed to quantify cross\u2010national inequalities in incidence. From 1990 to 2021, global hepatitis A cases declined by 7.25%, with age\u2010standardized incidence rates (ASIR) demonstrating a universal downward trend. The most substantial ASIR reductions occurred in low\u2010middle socio\u2010demographic index (SDI) quintiles, whereas low\u2010SDI quintiles showed paradoxical ASIR declines (AAPC: \u22121.56 95% CI: \u22121.71 to \u22121.40) alongside a 39.44% (95%UI: 28.04 to 50.48) case surge. Cases remained concentrated in children under 5. The age\u2010period\u2010cohort analysis confirmed highest risk in young children, with period and cohort risks declining over time. Decomposition analysis identified population growth as the primary driver of case increases. Health inequality analysis showed persistent absolute disparities despite relative improvements. Although global hepatitis A incidence has declined over three decades, trends are highly heterogeneous and significant inequalities persist. Achieving equitable burden reduction requires differentiated strategies and enhanced international collaboration, particularly for low\u2010resource settings.<\/jats:p>","DOI":"10.1002\/jmv.70838","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T07:36:26Z","timestamp":1770622586000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Global, Regional, and National Time Trends in Incidence for Hepatitis A, 1990\u20132021: A Systematic Analysis for the Global Burden of Disease 2021 Study"],"prefix":"10.1002","volume":"98","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0900-8570","authenticated-orcid":false,"given":"Aodi","family":"Huang","sequence":"first","affiliation":[{"name":"Shanghai Institute of Infectious Disease and Biosecurity Fudan University Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xia","family":"Xu","sequence":"additional","affiliation":[{"name":"Shanghai Municipal Center for Disease Control and Prevention Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Zhang","sequence":"additional","affiliation":[{"name":"Peoples Armed Police Force Wuhan Special Service Recuperation Center Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,8]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(98)01304-X"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.4254\/wjh.v4.i3.68"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2017.08.034"},{"key":"e_1_2_10_5_1","first-page":"227","article-title":"Hepatitis A and B Superimposed on Chronic Liver Disease: Vaccine\u2010Preventable Diseases","volume":"117","author":"Keeffe E. 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