Mortality Attributable to Hepatitis B and C in Italy, Romania, and Spain, 2022 Estimates

Background and Aims: Reliable data on viral hepatitis–related deaths remain limited, challenging assessment of progress towards the WHO elimination targets for mortality. To address this gap, we estimated hepatitis B- and C-attributable mortality in Italy, Romania, and Spain for 2022. Methods: Retrospective hospital data on decompensated cirrhosis and hepatocellular carcinoma cases were collected from sentinel sites in each of three countries using standard WHO protocol. The data were used to calculate fractions of these diseases attributable to hepatitis B and C. Adjusted and weighted attributable fractions were applied to national vital statistics data on deaths from cirrhosis and hepatocellular carcinoma from Eurostat to produce national hepatitis mortality estimates. Results: A total of 1733 cases of decompensated cirrhosis and hepatocellular carcinoma cases were enrolled into the study from sentinel sites across Italy, Romania, and Spain. We estimated that the share of decompensated cirrhosis deaths attributed to hepatitis B was: 8.7% in Italy, 16.8% in Romania and 1.8% in Spain. The respective share of hepatocellular carcinoma deaths attributed to hepatitis B was 19.0% in Italy, 31.2% in Romania and 4.9% in Spain. Hepatitis C accounted for 61.6% of hepatocellular carcinoma deaths in Italy, 36.5% in Romania, and 31.1% in Spain, as well as 32.9% of decompensated cirrhosis deaths in Italy, 18.8% in Romania and 12.7% in Spain. Overall, hepatitis B-related mortality per 100 000 population was 3.1 in Italy, 12.0 in Romania and 0.6 in Spain. Hepatitis C-related mortality was 11.4 per 100 000 population in Italy, 13.8 in Romania and 3.7 in Spain. Conclusions: Our study yielded empirical data needed to estimate hepatitis mortality for assessing the impact of hepatitis strategies. Whilst our results indicate a reduction in deaths related to hepatitis B and C in Italy and Spain, none of the three countries was meeting the WHO's 2025 target for hepatitis C-related mortality, although the hepatitis B-related mortality target was met by Italy and Spain. Our findings highlight the need for countries to continue strengthening efforts to prevent and control viral hepatitis and to integrate such assessments into national surveillance to guide effective targeting of interventions and monitoring of progress towards the elimination targets.