{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T00:32:14Z","timestamp":1793406734997,"version":"4.5.0"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T00:00:00Z","timestamp":1758758400000},"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. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hepatitis B virus and its complications remain a major global public health threat. This study aimed to assess the global, regional, and national trends of total burden related to hepatitis B among older adults aged \u226565\u202fyears from 1990 to 2021 and predict trend to 2030.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Drawing upon the Global Burden of Diseases (GBD) 2021, we obtained the data on incidence, prevalence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2021, categorized by sex, age, and socio-demographic index (SDI). Associations of. these metrics and SDI were analyzed. Secular trends were evaluated employing average annual percentage changes (AAPC) and joinpoint regression, with future trajectories estimated through 2030 using the Bayesian age-period-cohort (BAPC) model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From 1990 to 2021, the global age-standardized incidence rate (ASIR) of total burden related to hepatitis B among older adults aged \u226565\u202fyears declined from 710.53 to 591.79 per 100,000 population (AAPC \u22120.57%), and age-standardized DALYs rate (ASDR) declined from 927.65 to 605.93 per 100,000 population (AAPC -1.39%). ASIR and ASPR both showed significant decreasing trends in males and females, with persistently higher rates observed among males across all study years. The ASIR increased only in the &amp;gt;95\u202fyears age group, while a significant increase in DALYs was observed across all age strata, with the magnitude of increase escalating with advancing age. ASIR increased exclusively in high SDI countries (AAPC 0.16%). In 2021, Central Sub-Saharan Africa accounted for the peak ASIR (1,671.36 per 100,000 population), conversely North Africa and the Middle East showed the most pronounced ASDR decline (AAPC -2.74%). Both alcohol use and smoking emerged as the most consequential modifiable risk factors for DALYs in adults aged \u226565\u202fyears. Projections indicate declining trends in ASIR, ASDR, and ASMR for this population by 2030, whereas ASPR is projected to exhibit an upward trend.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The global burden and trends of total burden related to hepatitis B among older adults aged \u226565\u202fyears showed a significant decline, with projections indicating continued reduction by 2030. However, notable regional and national disparities persist. Key challenges in managing health risks for adults aged \u226565\u202fyears remain centered on alcohol use and smoking.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1654356","type":"journal-article","created":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T05:31:21Z","timestamp":1758778281000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["Global, regional, and national total burden related to hepatitis B and attributable risk factors in adults aged 65\u202fyears and older from 1990 to 2021 and projection to 2030"],"prefix":"10.3389","volume":"13","author":[{"given":"Linying","family":"Gao","sequence":"first","affiliation":[{"name":"School of Public Health, Shanxi Medical University","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanfeng","family":"Ren","sequence":"additional","affiliation":[{"name":"School of Public Health, Shanxi Medical University","place":["Taiyuan, China"]},{"name":"Center of Clinical Epidemiology and Evidence Based Medicine, Shanxi Medical University","place":["Taiyuan, China"]},{"name":"MOE Key Laboratory of Coal Environmental Pathogenicity and Prevention, Shanxi Medical University","place":["Taiyuan, China"]},{"name":"Research Center for Reverse Etiology, Workstation of Academician, Shanxi Medical University","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Songyue","family":"Hu","sequence":"additional","affiliation":[{"name":"School of Public Health, Shanxi Medical University","place":["Taiyuan, China"]},{"name":"Center of Clinical Epidemiology and Evidence Based Medicine, Shanxi Medical University","place":["Taiyuan, China"]},{"name":"MOE Key Laboratory of Coal Environmental Pathogenicity and Prevention, Shanxi Medical University","place":["Taiyuan, China"]},{"name":"Research Center for Reverse Etiology, Workstation of Academician, Shanxi Medical University","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yifan","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Public Health, Shanxi Medical University","place":["Taiyuan, China"]},{"name":"Center of Clinical Epidemiology and Evidence Based Medicine, Shanxi Medical University","place":["Taiyuan, China"]},{"name":"MOE Key Laboratory of Coal Environmental Pathogenicity and Prevention, Shanxi Medical University","place":["Taiyuan, China"]},{"name":"Research Center for Reverse Etiology, Workstation of Academician, Shanxi Medical University","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongjing","family":"Bai","sequence":"additional","affiliation":[{"name":"School of Public Health, Shanxi Medical University","place":["Taiyuan, China"]},{"name":"Center of Clinical Epidemiology and Evidence Based Medicine, Shanxi Medical University","place":["Taiyuan, China"]},{"name":"MOE Key Laboratory of Coal Environmental Pathogenicity and Prevention, Shanxi Medical University","place":["Taiyuan, China"]},{"name":"Research Center for Reverse Etiology, Workstation of Academician, Shanxi Medical University","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinbo","family":"Li","sequence":"additional","affiliation":[{"name":"School of Public Health, Shanxi Medical University","place":["Taiyuan, China"]},{"name":"Center of Clinical Epidemiology and Evidence Based Medicine, Shanxi Medical University","place":["Taiyuan, China"]},{"name":"MOE Key Laboratory of Coal Environmental Pathogenicity and Prevention, Shanxi Medical University","place":["Taiyuan, China"]},{"name":"Research Center for Reverse Etiology, Workstation of Academician, Shanxi Medical University","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keke","family":"Wang","sequence":"additional","affiliation":[{"name":"First Hospital of Shanxi Medical University","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suping","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Public Health, Shanxi Medical University","place":["Taiyuan, China"]},{"name":"Center of Clinical Epidemiology and Evidence Based Medicine, Shanxi Medical University","place":["Taiyuan, China"]},{"name":"MOE Key Laboratory of Coal Environmental Pathogenicity and Prevention, Shanxi Medical University","place":["Taiyuan, China"]},{"name":"Research Center for Reverse Etiology, Workstation of Academician, Shanxi Medical University","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongliang","family":"Feng","sequence":"additional","affiliation":[{"name":"School of Public Health, Shanxi Medical University","place":["Taiyuan, China"]},{"name":"Center of Clinical Epidemiology and Evidence Based Medicine, Shanxi Medical University","place":["Taiyuan, China"]},{"name":"MOE Key Laboratory of Coal Environmental Pathogenicity and Prevention, Shanxi Medical University","place":["Taiyuan, China"]},{"name":"Research Center for Reverse Etiology, Workstation of Academician, Shanxi Medical University","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"796","DOI":"10.1016\/S2468-1253(22)00124-8","article-title":"Global, regional, and national burden of hepatitis B, 1990-2019: a systematic analysis for the global burden of disease study 2019","volume":"7","year":"2022","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"ref2","first-page":"e701","article-title":"Hepatitis B and C in Europe: an update from the global burden of disease study 2019. Lancet","volume":"8","year":"2023","journal-title":"Public Health"},{"key":"ref3","volume-title":"Hepatitis B 2024","year":"2024"},{"key":"ref4","volume-title":"Global hepatitis report 2024: Action for access in low- and middle-income countries 2025","year":"2025"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1038\/s41575-023-00760-9","article-title":"Global burden of hepatitis B virus: current status, missed opportunities and a call for action","volume":"20","author":"Hsu","year":"2023","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"909","DOI":"10.1016\/j.bpg.2009.10.005","article-title":"Liver disorders in the elderly","volume":"23","author":"Floreani","year":"2009","journal-title":"Best Pract Res Clin Gastroenterol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1016\/S0140-6736(11)61138-0","article-title":"Extent of illicit drug use and dependence, and their contribution to the global burden of disease","volume":"379","author":"Degenhardt","year":"2012","journal-title":"Lancet"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1811","DOI":"10.2147\/CIA.S366255","article-title":"How to effectively monitor aging patients with chronic hepatitis B: a review","volume":"17","author":"Kang","year":"2022","journal-title":"Clin Interv Aging"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/s12992-023-00922-z","article-title":"Global burden of hepatitis B attributable to modifiable risk factors from 1990 to 2019: a growing contribution and its association with socioeconomic status","volume":"19","author":"Wang","year":"2023","journal-title":"Glob Health"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e1225","DOI":"10.1016\/S2214-109X(23)00267-X","article-title":"Prevalence of injecting drug use and HIV, hepatitis B, and hepatitis C in people who inject drugs in the eastern Mediterranean region: a systematic review and meta-analysis","volume":"11","author":"Aghaei","year":"2023","journal-title":"Lancet Glob Health"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"2936","DOI":"10.1186\/s12889-024-20462-4","article-title":"Global, regional, and national total burden related to hepatitis B in children and adolescents from 1990 to 2021","volume":"24","author":"Li","year":"2024","journal-title":"BMC Public Health"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.1016\/S0140-6736(20)30925-9","article-title":"Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the global burden of disease study 2019","volume":"396","year":"2020","journal-title":"Lancet"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"2133","DOI":"10.1016\/S0140-6736(24)00757-8","article-title":"Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the global burden of disease study 2021","volume":"403","year":"2024","journal-title":"Lancet"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"2162","DOI":"10.1016\/S0140-6736(24)00933-4","article-title":"Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990-2021: a systematic analysis for the global burden of disease study 2021","volume":"403","year":"2024","journal-title":"Lancet"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"102873","DOI":"10.1016\/j.eclinm.2024.102873","article-title":"The global, regional, and national patterns of change in the burden of congenital birth defects, 1990-2021: an analysis of the global burden of disease study 2021 and forecast to 2040","volume":"77","author":"Bai","year":"2024","journal-title":"EClinicalMedicine"},{"key":"ref16","volume-title":"Disability-adjusted life years (DALYs) 2020","year":"2024"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1989","DOI":"10.1016\/S0140-6736(24)00476-8","article-title":"Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950-2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the global burden of disease study 2021","volume":"403","year":"2024","journal-title":"Lancet"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1015","DOI":"10.1016\/S0140-6736(18)31310-2","article-title":"Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the global burden of disease study 2016","volume":"392","year":"2018","journal-title":"Lancet"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"2232","DOI":"10.1111\/all.15807","article-title":"Global, regional, and national burden of allergic disorders and their risk factors in 204 countries and territories, from 1990 to 2019: a systematic analysis for the global burden of disease study 2019","volume":"78","author":"Shin","year":"2023","journal-title":"Allergy"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1016\/S2468-1253(22)00044-9","article-title":"Global, regional, and national burden of colorectal cancer and its risk factors, 1990-2019: a systematic analysis for the global burden of disease study 2019","volume":"7","author":"Sharma","year":"2022","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"103848","DOI":"10.1016\/j.numecd.2025.103848","article-title":"The stroke burden in China and its long-term trends: insights from the global burden of disease (GBD) study 1990-2021","volume":"35","author":"Ji","year":"2025","journal-title":"Nutr Metab Cardiovasc Dis"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1007\/s12072-023-10531-y","article-title":"Global, regional, and national burdens of cirrhosis in children and adolescents aged under 19 years from 1990 to 2019","volume":"18","author":"Zhang","year":"2024","journal-title":"Hepatol Int"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1186\/s12874-020-01133-5","article-title":"An R package for an integrated evaluation of statistical approaches to cancer incidence projection","volume":"20","author":"Knoll","year":"2020","journal-title":"BMC Med Res Methodol"},{"key":"ref24","volume-title":"Global Issues Ageing 2024","year":"2024"},{"key":"ref25","volume-title":"World social report 2023: Leaving no one behind in An ageing world","year":"2024"},{"key":"ref26","volume-title":"Global hepatitis report 2024: Action for access in low- and middle-income countries","year":"2024"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"2354","DOI":"10.1136\/gutjnl-2023-330691","article-title":"Changing prevalence of chronic hepatitis B virus infection in China between 1973 and 2021: a systematic literature review and meta-analysis of 3740 studies and 231 million people","volume":"72","author":"Liu","year":"2023","journal-title":"Gut"},{"key":"ref28","volume-title":"Annual Progress report 2022","year":"2022"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"116666","DOI":"10.1016\/j.diagmicrobio.2024.116666","article-title":"Advancing hepatitis B elimination: a systematic review of global immunization progress and future directions","volume":"111","author":"Madihi","year":"2025","journal-title":"Diagn Microbiol Infect Dis"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"a021410","DOI":"10.1101\/cshperspect.a021410","article-title":"Hepatitis B virus epidemiology","volume":"5","author":"MacLachlan","year":"2015","journal-title":"Cold Spring Harb Perspect Med"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1038\/ajg.2012.7","article-title":"Viral hepatitis in the elderly","volume":"107","author":"Carrion","year":"2012","journal-title":"Am J Gastroenterol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"e70004","DOI":"10.1111\/liv.70004","article-title":"The burden of hepatitis B and C in Asia, 1990-2019: An update analysis from the global burden of disease study 2019","volume":"45","author":"Chen","year":"2025","journal-title":"Liver Int"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"625","DOI":"10.3390\/vaccines9060625","article-title":"Knowledge, vaccination status, and reasons for avoiding vaccinations against hepatitis B in developing countries: a systematic review","volume":"9","author":"Machmud","year":"2021","journal-title":"Vaccines"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"e715","DOI":"10.1016\/S2214-109X(23)00131-6","article-title":"Risk of early horizontal transmission of hepatitis B virus in children of uninfected mothers in sub-Saharan Africa: a systematic review and meta-analysis","volume":"11","author":"Ansari","year":"2023","journal-title":"Lancet Glob Health"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"3768","DOI":"10.1016\/j.apsb.2021.09.005","article-title":"Environmental exposure as a risk-modifying factor in liver diseases: knowns and unknowns","volume":"11","author":"Beier","year":"2021","journal-title":"Acta Pharm Sin B"},{"key":"ref36","volume-title":"Social panorama of Latin America and the Caribbean 2022: Transforming education as a basis for sustainable development 2022","year":"2022"},{"key":"ref37","doi-asserted-by":"crossref","first-page":"J43","DOI":"10.1016\/j.vaccine.2012.11.057","article-title":"Evaluation of immunization injection safety in China, 2010: achievements, future sustainability","volume":"31","author":"Wu","year":"2013","journal-title":"Vaccine"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"04131","DOI":"10.7189\/jogh.13.04131","article-title":"The state and significant drivers of health systems efficiency in Africa: a systematic review and meta-analysis","volume":"13","author":"Nabyonga-Orem","year":"2023","journal-title":"J Glob Health"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1016\/j.jhep.2016.10.013","article-title":"Battlefield against hepatitis B infection and HCC in Africa","volume":"66","author":"Lemoine","year":"2017","journal-title":"J Hepatol"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"782","DOI":"10.15585\/mmwr.mm7229a2","article-title":"Progress toward hepatitis B control and elimination of mother-to-child transmission of hepatitis B virus - World Health Organization African region, 2016-2021","volume":"72","author":"Kabore","year":"2023","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"104006","DOI":"10.1016\/j.drugpo.2023.104006","article-title":"\"harm per litre\" as a concept and a measure in studying determinants of relations between alcohol consumption and harm","volume":"115","author":"Room","year":"2023","journal-title":"Int J Drug Policy"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"107293","DOI":"10.1016\/j.ijid.2024.107293","article-title":"Total burden of hepatitis B and C attributed to injecting drug use in 204 countries and territories from 1990 to 2021: analyses based on the global burden of disease study 2021","volume":"150","author":"Huang","year":"2025","journal-title":"Int J Infect Dis"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1016\/S0140-6736(25)00355-1","article-title":"Global, regional, and national prevalence of adult overweight and obesity, 1990-2021, with forecasts to 2050: a forecasting study for the global burden of disease study 2021","volume":"405","year":"2025","journal-title":"Lancet"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1385","DOI":"10.1016\/S1473-3099(16)30325-5","article-title":"Estimating the burden of disease attributable to injecting drug use as a risk factor for HIV, hepatitis C, and hepatitis B: findings from the global burden of disease study 2013","volume":"16","author":"Degenhardt","year":"2016","journal-title":"Lancet Infect Dis"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"1357","DOI":"10.1002\/cam4.4530","article-title":"The burden of primary liver cancer caused by specific etiologies from 1990 to 2019 at the global, regional, and national levels","volume":"11","author":"Yang","year":"2022","journal-title":"Cancer Med"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1186\/s12889-025-22026-6","article-title":"Global, regional and national burden of liver cancer 1990-2021: a systematic analysis of the global burden of disease study 2021","volume":"25","author":"Jiang","year":"2025","journal-title":"BMC Public Health"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1111\/hepr.13600","article-title":"Impact of antiviral therapy on risk prediction model for hepatocellular carcinoma development in patients with chronic hepatitis B","volume":"51","author":"Chon","year":"2021","journal-title":"Hepatol Res"}],"updated-by":[{"DOI":"10.3389\/fpubh.2026.1782146","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T00:00:00Z","timestamp":1769644800000}}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1654356\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T14:37:56Z","timestamp":1769697476000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1654356\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,25]]},"references-count":47,"alternative-id":["10.3389\/fpubh.2025.1654356"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1654356","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,25]]},"article-number":"1654356"}}