{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T06:15:34Z","timestamp":1788156934657,"version":"build-2803163510"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Epidemiol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess long-term trends, seasonality, forecasts, and ecological associations with tourist visits for reported hepatitis B virus (HBV) and hepatitis C virus (HCV) incidence in Hainan Province from 2005 to 2020.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Reported HBV and HCV incidence data from Hainan, national Global Burden of Disease (GBD) estimates for China, and annual tourist visit data were analyzed. Joinpoint regression assessed temporal trends, seasonal-trend decomposition using loess evaluated monthly variation, and seasonal autoregressive integrated moving average models generated forecasts. Spearman rank correlation analysis examined tourism associations, with sensitivity analyses excluding 2020 and using first-differenced and linearly detrended series.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Reported HBV incidence declined from 2005 to 2008, increased from 2008 to 2018, and then showed a non-significant decline through 2020; the overall average annual percent change (AAPC) was +3.37%. Reported HCV incidence increased until 2015 and subsequently declined, with an overall AAPC of +14.54%. National GBD estimates showed overall AAPCs of \u22120.54% for HBV and \u22121.52% for HCV. No significant differences among calendar months were detected. Under continuation of historical reporting patterns, the annualized projected reported HBV incidence in 2030 was 12.00 per 100,000 population (95% prediction interval: approximately 0.00\u2013121.20), numerically close to the study-defined reference value of 12.20. The corresponding HCV estimate was 22.54 per 100,000 population (approximately 0.00\u201339.10), approximately 6.4 times the study-defined reference value of 3.55. The wide prediction intervals indicated substantial long-term forecast uncertainty. In 2020, observed mean monthly reported HBV and HCV incidence rates were 27.3% and 9.5% lower than forecasted values, respectively. In raw annual analyses, tourist visits correlated with reported HBV and HCV incidence\n                      <jats:italic>(r<\/jats:italic>\n                      \u2009=\u20090.871 and 0.879; both\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). After first differencing and linear detrending, the association remained significant only for reported HBV incidence.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Reported HBV and HCV incidence in Hainan showed distinct phased changes without significant monthly differences. The forecasts represent projections under historical reporting patterns and should not be interpreted as evidence of progress toward WHO elimination targets. Tourism associations were exploratory and ecological and do not support causal inference. Continued surveillance and strengthened HCV screening, diagnosis, and linkage to treatment remain important.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fepid.2026.1899759","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T05:39:44Z","timestamp":1788154784000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Trends and forecasting of reported hepatitis B and hepatitis C incidence in Hainan Province, China, 2005\u20132020"],"prefix":"10.3389","volume":"6","author":[{"given":"Jiao","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Hainan Af\ufb01liated Hospital of Hainan Medical University, Hainan General Hospital","place":["Haikou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shibing","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Hainan Af\ufb01liated Hospital of Hainan Medical University, Hainan General Hospital","place":["Haikou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cexiong","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary and Pancreatic Surgery, Hainan Af\ufb01liated Hospital of Hainan Medical University, Hainan General Hospital","place":["Haikou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Hainan Af\ufb01liated Hospital of Hainan Medical University, Hainan General Hospital","place":["Haikou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanrong","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Hainan Af\ufb01liated Hospital of Hainan Medical University, Hainan General Hospital","place":["Haikou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanyuan","family":"Tian","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hainan Af\ufb01liated Hospital of Hainan Medical University, Hainan General Hospital","place":["Haikou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng","family":"Lan","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hainan Af\ufb01liated Hospital of Hainan Medical University, Hainan General Hospital","place":["Haikou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1016\/j.jhep.2025.01.013","article-title":"Number of people treated for hepatitis C virus infection in 2014\u20132023 and applicable lessons for new HBV and HDV therapies","volume":"83","year":"2025","journal-title":"J Hepatol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"724","DOI":"10.1016\/s2468-1253(22)00050-4","article-title":"Worldwide prevalence of hepatitis B virus and hepatitis C virus among patients with cirrhosis at country, region, and global levels: a systematic review","volume":"7","author":"Alberts","year":"2022","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1007\/s11427-024-2722-2","article-title":"Epidemiology of liver diseases: global disease burden and forecasted research trends","volume":"682","author":"Xiao","year":"2025","journal-title":"Sci China Life Sci"},{"key":"B4","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1016\/s2468-1253(22)00386-7","article-title":"Global reporting of progress towards elimination of hepatitis B and hepatitis C","volume":"84","author":"Cui","year":"2023","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"34","DOI":"10.3390\/v17010034","article-title":"Asian Perspective on hepatitis B virus and hepatitis C virus elimination","volume":"171","author":"Kaewdech","year":"2024","journal-title":"Viruses"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1115087","DOI":"10.3389\/fcimb.2023.1115087","article-title":"Spatiotemporal heterogeneity and impact factors of hepatitis B and C in China from 2010 to 2018: bayesian space-time hierarchy model","volume":"13","author":"Qian","year":"2023","journal-title":"Front Cell Infect Microbiol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"884598","DOI":"10.3389\/fmicb.2022.884598","article-title":"Feasibility of hepatitis C elimination in China: from epidemiology, natural history, and intervention perspectives","volume":"13","author":"Zhao","year":"2022","journal-title":"Front Microbiol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1186\/s12889-023-17587-3","article-title":"Evaluating the impact of COVID-19 outbreak on hepatitis B and forecasting the epidemiological trend in mainland China: a causal analysis","volume":"241","author":"He","year":"2024","journal-title":"BMC Public Health"},{"key":"B9","doi-asserted-by":"publisher","first-page":"105553","DOI":"10.1016\/j.jcv.2023.105553","article-title":"Impact of the COVID-19 pandemic on hospital admissions due to viral hepatitis in Spain","volume":"167","author":"Ramos-Rincon","year":"2023","journal-title":"J Clin Virol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1007130","DOI":"10.3389\/fpubh.2022.1007130","article-title":"Molecular prevalence and genetic diversity analysis of enterocytozoon bieneusi in humans in Hainan Province, China: high diversity and unique endemic genetic characteristics","volume":"10","author":"Zhang","year":"2022","journal-title":"Front Public Health"},{"key":"B11","doi-asserted-by":"publisher","first-page":"338","DOI":"10.3390\/e25020338","article-title":"Forecasting tourist arrivals for hainan island in China with decomposed broad learning before the COVID-19 pandemic","volume":"252","author":"Chen","year":"2023","journal-title":"Entropy (Basel)"},{"key":"B12","doi-asserted-by":"publisher","first-page":"764977","DOI":"10.3389\/fpubh.2021.764977","article-title":"China\u2019s hainan free trade port: medical laws and policy reform","volume":"9","author":"Qi","year":"2021","journal-title":"Front Public Health"},{"key":"B13","doi-asserted-by":"publisher","first-page":"e35054","DOI":"10.1097\/md.0000000000035054","article-title":"Prediction of reported monthly incidence of hepatitis B in Hainan Province of China based on SARIMA-BPNN model","volume":"10241","author":"Fang","year":"2023","journal-title":"Medicine (Baltimore)"},{"key":"B14","doi-asserted-by":"publisher","first-page":"739828","DOI":"10.3389\/fpubh.2021.739828","article-title":"Epidemiological characteristics of infectious diseases among travelers between China and foreign countries before and during the early stage of the COVID-19 pandemic","volume":"9","author":"Luo","year":"2021","journal-title":"Front Public Health"},{"key":"B15","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1002\/(SICI)1097-0258(20000215)19:3<335::AID-SIM336>3.0.CO;2-Z","article-title":"Permutation tests for joinpoint regression with applications to cancer rates","volume":"193","author":"Kim","year":"2000","journal-title":"Stat Med"},{"key":"B16","doi-asserted-by":"publisher","first-page":"3670","DOI":"10.1002\/sim.3733","article-title":"Estimating average annual per cent change in trend analysis","volume":"2829","author":"Clegg","year":"2009","journal-title":"Stat Med"},{"key":"B17","doi-asserted-by":"publisher","first-page":"39350","DOI":"10.1038\/srep39350","article-title":"Epidemiological analysis of hemorrhagic fever with renal syndrome in China with the seasonal-trend decomposition method and the exponential smoothing model","volume":"6","author":"Ke","year":"2016","journal-title":"Sci Rep"},{"key":"B18","doi-asserted-by":"publisher","first-page":"e25050","DOI":"10.1002\/jia2.25050","article-title":"How far are we from viral hepatitis elimination service coverage targets?","volume":"21","author":"Hutin","year":"2018","journal-title":"J Int AIDS Soc"},{"key":"B19","doi-asserted-by":"publisher","first-page":"727","DOI":"10.46234\/ccdcw2024.164","article-title":"Trends and age-period-cohort effect on acute hepatitis B incidence\u2014china, 2005\u20132021","volume":"630","author":"Wang","year":"2024","journal-title":"China CDC wkly"},{"key":"B20","doi-asserted-by":"publisher","first-page":"13370","DOI":"10.1038\/s41598-024-63796-0","article-title":"Trends and age-period-cohort effect on incidence of hepatitis B from 2008 to 2022 in Guangzhou, China","volume":"141","author":"Zheng","year":"2024","journal-title":"Sci Rep"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1276","DOI":"10.1186\/s12889-025-22452-6","article-title":"Spatial and temporal distribution patterns and factors influencing hepatitis B in China: a geo-epidemiological study","volume":"251","author":"Fang","year":"2025","journal-title":"BMC Public Health"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1276","DOI":"10.1016\/j.idm.2024.08.001","article-title":"Trends and multi-model prediction of hepatitis B incidence in Xiamen","volume":"94","author":"Zhang","year":"2024","journal-title":"Infect Dis Model"},{"key":"B23","doi-asserted-by":"publisher","first-page":"66","DOI":"10.21037\/hbsn-2024-754","article-title":"2024 Latest report on hepatitis B virus epidemiology in China: current status, changing trajectory, and challenges","volume":"141","author":"Yan","year":"2025","journal-title":"Hepatobiliary Surg Nutr"},{"key":"B24","doi-asserted-by":"publisher","first-page":"2079","DOI":"10.1186\/s12889-025-22847-5","article-title":"Age-period-cohort and Bayesian age-period-cohort prediction modeling of hepatitis C incidence and mortality in China","volume":"251","author":"Lin","year":"2025","journal-title":"BMC Public Health"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1041201","DOI":"10.3389\/fpubh.2023.1041201","article-title":"The burden of hepatitis C virus in the world, China, India, and the United States from 1990 to 2019","volume":"11","author":"Yang","year":"2023","journal-title":"Front Public Health"},{"key":"B26","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1186\/s12879-025-10778-w","article-title":"Epidemiological characteristics and spatiotemporal distribution of hepatitis C in southeast coastal areas of China from 2015 to 2022","volume":"251","author":"Liu","year":"2025","journal-title":"BMC Infect Dis"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1383","DOI":"10.1111\/liv.15875","article-title":"Impact of new direct-acting antiviral therapy on the prevalence and undiagnosed proportion of chronic hepatitis C infection","volume":"446","author":"Forouzannia","year":"2024","journal-title":"Liver Int"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1421","DOI":"10.1007\/s00210-023-02716-x","article-title":"Assessing the impact of direct-acting antivirals on hepatitis C complications: a systematic review and meta-analysis","volume":"3973","author":"Yew","year":"2024","journal-title":"Naunyn Schmiedebergs Arch Pharmacol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"5716","DOI":"10.3748\/wjg.v29.i42.5716","article-title":"Time series analysis-based seasonal autoregressive fractionally integrated moving average to estimate hepatitis B and C epidemics in China","volume":"2942","author":"Wang","year":"2023","journal-title":"World J Gastroenterol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"464","DOI":"10.16250\/j.32.1374.2023068","article-title":"Burden of hepatitis B-associated diseases in China from 1990 to 2030","volume":"355","author":"Yao","year":"2023","journal-title":"Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi"},{"key":"B31","doi-asserted-by":"publisher","first-page":"476","DOI":"10.16250\/j.32.1374.2023059","article-title":"Analysis and prediction of burden of viral hepatitis C-associated diseases in China from 1990 to 2044","volume":"355","author":"Zhou","year":"2023","journal-title":"Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi"},{"key":"B32","doi-asserted-by":"publisher","first-page":"e0257369","DOI":"10.1371\/journal.pone.0257369","article-title":"Australia Could miss the WHO hepatitis C virus elimination targets due to declining treatment uptake and ongoing burden of advanced liver disease complications","volume":"169","author":"Kwon","year":"2021","journal-title":"PLoS One"},{"key":"B33","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1055\/a-1777-6112","article-title":"A global systematic review of hepatitis C elimination efforts through micro-elimination","volume":"422","author":"Lazarus","year":"2022","journal-title":"Semin Liver Dis"},{"key":"B34","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1186\/s40249-025-01275-y","article-title":"Global progress, challenges and strategies in eliminating public threat of viral hepatitis","volume":"141","author":"Zhang","year":"2025","journal-title":"Infect Dis Poverty"},{"key":"B35","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1007\/s44197-024-00273-x","article-title":"Impact of the COVID-19 pandemic on the incidence of notifiable infectious diseases in China based on SARIMA models between 2013 and 2021","volume":"14","author":"Liu","year":"2024","journal-title":"J Epidemiol Glob Health"},{"key":"B36","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1016\/j.puhe.2024.04.006","article-title":"Impact of the COVID-19 pandemic on the Italian national viral hepatitis surveillance: an interrupted time series analysis, 2006\u20132022","volume":"232","author":"Russotto","year":"2024","journal-title":"Public Health"},{"key":"B37","doi-asserted-by":"publisher","first-page":"e948512","DOI":"10.12659\/msm.948512","article-title":"Decade-Long analysis of hepatitis trends among international travelers at Shanghai port (2013\u20132023)","volume":"31","author":"Ju","year":"2025","journal-title":"Med Sci Monit"},{"key":"B38","doi-asserted-by":"publisher","first-page":"103949","DOI":"10.1016\/j.jag.2024.103949","article-title":"Optimizing the detection of emerging infections using mobility-based spatial sampling","volume":"131","author":"Zhang","year":"2024","journal-title":"Int J Appl Earth Obs Geoinf"}],"container-title":["Frontiers in Epidemiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fepid.2026.1899759\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T05:39:46Z","timestamp":1788154786000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fepid.2026.1899759\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,31]]},"references-count":38,"alternative-id":["10.3389\/fepid.2026.1899759"],"URL":"https:\/\/doi.org\/10.3389\/fepid.2026.1899759","relation":{},"ISSN":["2674-1199"],"issn-type":[{"value":"2674-1199","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,31]]},"article-number":"1899759"}}