Hepatitis B and Hepatitis C notification

Published

24 Jun, 2022

Chronic hepatitis B and C infections are the most common risk factor for liver cancer.¹ Together these diseases are estimated to account for 80% of liver cancers globally.² Studies indicate that the risk of developing liver cancer can be 20-30 times higher in people with chronic hepatitis infection than among the general population.^3,4

It was estimated that in 2021, there were 2,832 new diagnoses and 2,424 deaths due to liver cancer in Australia. In addition, the age-standardised mortality rate for liver cancer has increased over time, from 1.6 deaths per 100,000 persons in 1980 to 7.4 deaths per 100,000 in 2021 (see NCCI Indicator – Mortality).

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Hepatitis B or C

Notes

• Data sourced from the Kirby Institute’s Latest Surveillance data: interactive data display from based on notifications made to the Australian National Notifiable Diseases Surveillance System.
• Total includes data where sex is unknown.

New diagnoses of Hepatitis B and Hepatitis C infection, 2010-2019
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Hepatitis B and Hepatitis C notification rate per 100,000 population, 2010-2019
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Hepatitis B and Hepatitis C notification rate per 100,000 population, by remoteness and sex, 2010-2019
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Notes

• Data sourced from the Kirby Institute’s National update on HIV, viral hepatitis and sexually transmissible infections in Australia: 2009–2018, based on notifications made to the Australian National Notifiable Diseases Surveillance System.
• Includes data from Australian Capital Territory, Northern Territory, Queensland, South Australia, Tasmania, Victoria and Western Australia for Hepatitis B and Hepatitis C.

Hepatitis B and Hepatitis C notification rate per 100,000 population, by Indigenous status over time, 2014-2018

About this measure

In Australia, the prevalence of chronic hepatitis B is approximately 0.9% and of hepatitis C is approximately 0.05% of the population,⁵ with a higher prevalence in people born in high-risk settings (e.g., Vietnam, Cambodia, China, Taiwan and Afghanistan) and in Aboriginal and Torres Strait Islander peoples.^6,7 This measure focuses on people newly diagnosed with hepatitis B or hepatitis C (including people with newly acquired and unspecified duration of infection) as notified through the Australian National Notifiable Diseases Surveillance System.

There are multiple risk factors for acquiring hepatitis B, including injecting drug use and unprotected sex, although most people living with chronic hepatitis B in Australia acquired their infection at birth or in early childhood.⁷ Childhood immunization with the hepatitis B vaccine therefore has an important role to play in reducing the risk of acquiring this disease (see NCCI Indicator – Hepatitis B vaccination). It is estimated that in 2017, only 64% of people with chronic hepatitis B in Australia had been diagnosed with the disease.⁷

The primary risk factor for hepatitis C is re-use of needles and syringes, such that hepatitis C tends to be concentrated among people who inject drugs, prisoners, and people from high prevalence countries.⁷

Current status

Hepatitis B notifications

In 2019 there was a total of 5,840 hepatitis B notifications in Australia, with more than half of them (54%, 3,139) occurring in males (compared to 2,680 for females).

The notification rate for hepatitis B in 2019 was 23.2 cases per 100,000 for persons, and slightly higher in males (25.3 cases per 100,000) than females (21.0 cases per 100,000).

By age and sex

In 2019, notification rates for hepatitis B were marginally higher at ages 30–34 and 35-39 years (52.2 and 49.3 per 100,000 persons, respectively).⁷ The largest difference in notification rate by sex was in the 35-39 age group, where the rate was higher among males than females (54.1 compared with 44.4 per 100,000).

Aboriginal and Torres Strait Islander peoples

Data for hepatitis B and hepatitis C notifications by Indigenous status are available for a limited number of jurisdictions, and therefore should be treated with caution as they may not be representative (refer to About the Data).

In 2019, hepatitis B notification rates were slightly higher among Aboriginal and Torres Strait Islander peoples (24.5 per 100,000) than among non-Indigenous people (18.3 per 100,000).⁹ The hepatitis B notification rate was higher among males (32.2 per 100,000) than females (18.0 per 100,000).⁹

Remoteness

In 2019, the notification rate for hepatitis B was highest in Major Cities (26.8 per 100,000 persons), and lowest in Regional areas (10.6 per 100,000 persons).

Hepatitis C notifications

In 2019, there was a total of 9,230 hepatitis C notifications in Australia, with more than two-thirds of these (69%, 6,338) occurring in males.

The notification rate for hepatitis C in 2019 was 36.6 per 100,000 persons, and higher in males (50.9 per 100,000) than in females (22.4 per 100,000).

By age and sex

In 2019, notification rates for hepatitis C were highest in the 25–39 years old age group (59.4 per 100,000 persons).⁹ Notification rates were more than 2-fold higher in males than females for each age group, i.e., for 15–24 years (47.7 compared to 17.9 per 100,00), for 25–39 years (82.8 compared to 35.9 per 100,000), and for 40 years and over (56.6 compared to 25.4 per 100,000). Notification rates for males and females in the 0-14 age group were the same (0.9 per 100,000).

Aboriginal and Torres Strait Islander peoples

In 2019, hepatitis C notification rates were 6.3 times greater among Aboriginal and Torres Strait Islander peoples than for non-Indigenous people, (198.6 per 100,000 population compared to 31.3 per 100,000 population respectively).⁸

Of the 9,230 hepatitis C notifications in 2019, about 1 in 7 cases (14%) identified as Aboriginal or Torres Strait Islander. Notably for over one-third (3,554, 38.5%), Aboriginal or Torres Strait Islander status was not reported. Aboriginal and Torres Strait Islanders represent around 3% of the Australian population,⁷ indicating that at 14% of cases, Aboriginal and Torres Strait Islanders have a disproportionately high burden of Hepatitis C (especially in the context of large number of unknown status).

The hepatitis C notification rate in 2019 was 282.2 cases per 100,000 population for Indigenous males, compared to 114.5 cases per 100,000 for Indigenous females. A higher notification rate for males compared to females was also seen for non-Indigenous people (43.8 compared to 18.9 per 100,000 population, respectively).⁹

Of note, in 2019, more than 97% of Hepatitis C cases occurred in Australians aged over 20 years and over 51% occurred in the 40+ year age-group.⁹

Remoteness [Chart 3]

In 2019, notification rates for Hepatitis C were highest Major Cities (26.8 per 100,000 population). Remote and Regional areas had lower notification rates (19.3 and 10.6 per 100,000 respectively)

Within each region, notification rates were higher for males than females – i.e., in Regional areas, 11.4 compared to 9.8 per 100,000 population; in Remote areas, 21.8 compared to 16.3 per 100,000 population; and in Major Cities: 21.8 compared to 16.3 per 100,000 population.

Trends

The notification rates for hepatitis B and hepatitis C have both decreased over time. Notification rates for both diseases were higher in 2010 (31.1 and 49.9 cases per 100,000 population respectively) than in 2019 (23.2 and 36.6 cases per 100,000 population).

Hepatitis B

Age groups

Between 2010 and 2019, ages 25-29, 30-34 and 35-39 years had the highest Hepatitis B notification rates, all of which decreased over this period from 71.6 to 35.3; 70.4 to 52.2; and 53.4 to 49.3 per 100,000 respectively. During this same period, notification rates for ages over 40 years remained stable, whereas they decreased in ages 5-19 and 20-24 years from 19.0 to 7.5 and 43.2 to 17.9 per 100,000 persons respectively. Similar trends were observed for both sexes within each of these age groups.

For Aboriginal and Torres Strait Islander notification rates, please refer to the Aboriginal and Torres Strait Islander Cancer Control Indicators – Notification of Hepatitis B and C notifications

Aboriginal and Torres Strait Islander peoples

Over the period 2015-2019, the age-standardised Hepatitis B notification rate in the Aboriginal and Torres Strait Islander population decreased by over 50% from 52.7 to 24.5 per 100,000 population. During this same period, a decrease of 14%, from 21.3 to 18.3 per 100,000 population was observed in the non-Indigenous population.

Between 2015 and 2019, Hepatitis B notification rates were consistently higher in Indigenous males, compared to Indigenous females. This pattern of higher notification rates in males compared to females was also observed in the non-Indigenous population.

Remoteness

In 2008, Hepatitis B notification rates were highest in Remote and Very Remote areas combined (46 per 100,000 population), followed by Major Cities (35 per 100,000 population) and Inner and Outer Regional areas (13 per 100,000 population). In 2019, all regions reported a decrease in notification rates, with the highest rate applying in Major Cities (26.8 per 100,000 population) followed by Remote (19.3 per 100,000 population) and Regional areas (10.6 per 100,000 population).

This pattern of notification rates for 2008 to 2019 was also observed by sex for Major Cities. By comparison, Regional and Remote notification rates were less consistent in 2010-2013, with a high variation between males and females (notifications per 100,000 population for 2010: 34.3 for males and 46.4 for females; for 2011: 41.6 for males and 32.7 for female; for 2012: 37.9 for males and 27.2 for females; and for 2013, 42.3 for males and 30.0 for females).

In 2008, Hepatitis B notification rates for males and females were highest in Remote and Very Remote areas combined (50 and 41 per 100,000 population respectively), followed by Major Cities (38 and 32 per 100,000 population respectively) and Inner and outer regional areas (16 and 11 per 100,000 population respectively). During 2019, notification rates per 100,000 population were highest in Major Cities (29.1 and 24.4 respectively) followed by Remote areas (21.8 and 16.3 respectively) and Regional areas (11.4 and 9.8 respectively).

For Aboriginal and Torres Strait Islander notification rates, please refer to the Aboriginal and Torres Strait Islander Cancer Control Indicators – Notification of Hepatitis B and C notifications

Hepatitis C

Age groups

Between 2010 and 2019, ages 25-39 years had the highest Hepatitis C notification rate, which decreased by 38% over this period from 95.9 per 100,000 persons in 2010, to 59.4 per 100,000 in 2019. During the same period, notifications for ages over 40 years and 15-24 years remained relatively stable (51 to 40.6 per 100,000 persons and 38.0 to 33.2 per 100,000 persons respectively). Similar trends were observed for both sexes within each of these age groups.

For Aboriginal and Torres Strait Islander notification rates, please refer to the M&R Framework

Aboriginal and Torres Strait Islander peoples

Over the period 2015-2019, the age-standardised Hepatitis C notification rate in the Aboriginal and Torres Strait Islander population increased by 15%, from 173.1 to 198.6 per 100,000 population. This increase may reflect a greater exposure to injecting risk behaviours and relatively high rates of incarceration among Aboriginal and Torres Strait Islander peoples.⁸ During this same period, a corresponding decrease in notification rate of 25% was observed from 42.0 to 31.3 per 100,000 non-Indigenous people.

Between 2015 and 2019, Hepatitis C notification rates were consistently higher in Indigenous males than Indigenous females. This pattern of higher notifications in males was also observed in the non-Indigenous population.

Differences by sex during 2015-2019 were as follows:

Hepatitis C notification rates increased by 19% from 236.4 to 282.2 per 100,000 for Indigenous males and increased by 3% from 111.1 to 114.5 per 100,000 for Indigenous females.
Hepatitis C notification rates decreased in non-Indigenous people from 56.1 to 43.8 per 100,000 for males (22% decrease) and 28.0 to 18.9 per 100,000 for females (33% decrease).

Remoteness

Between 2010 and 2019, notification rates for Hepatitis C were highest in Major Cities but remained relatively stable during this period (14% decrease). In contrast, notification rates in Remote areas decreased by 52% (39.9 to 19.3 per 100,000 population), and in Regional areas by 21% (13.5 to 10.6 per 100,000 population). The overall trend for remoteness areas was a decrease in notification rates.

During 2010-2019, notification rates for males indicated a relatively stable decrease in Regional areas (20% decrease) and Major Cities (23% decrease), but fluctuated in Remote areas (an overall 36% decrease, 34.3 to 21.8 per 100,000 population, with a peak in 2013 at 42.3 per 100,00 population). For females, a decrease in notification rates was observed across all regions, with the highest being 65% in Remote areas (46.4 to 16.3 per 100,000 population) and a 28% decrease in Major Cities (33.8 to 24.4 per 100,000 population), and in Regional areas (12.5 to 9.8 per 100,000 population).

For Aboriginal and Torres Strait Islander notification rates, please refer to the M&R Framework

About the data

This measure shows the number and rate per 100,000 population of people newly diagnosed with hepatitis B or hepatitis C in Australia, which include both newly acquired (acquired within two years before diagnosis) and unspecified (do not meet ‘newly acquired’ criteria and were acquired more than two years before diagnosis) cases.

Numerator: People newly diagnosed with hepatitis B or hepatitis C in Australia (both newly acquired and unspecified), as recorded in the National Notifiable Diseases Surveillance System.

Denominator: Estimated residential population Australia.

Data sources:

Australian data are from the National Notifiable Diseases Surveillance System (NNDS). The NNDS collates disease notifications made to the relevant state or territory health authorities under the provisions of the public health legislation in each jurisdiction. Hepatitis B and hepatitis C are notifiable diseases in all states and territories. More information on the NNDS is available at http://www.health.gov.au/internet/main/publishing.nsf/content/cda-surveil-nndss-nndssintro.htm.

Extensive analyses of NNDS data relevant to this measure are provided in annual surveillance reports, and interactive latest surveillance data produced by the Kirby Institute for infection and immunity in society.^7,8,9 The National update on HIV, viral hepatitis and sexually transmissible infections in Australia 2009-2018 and the Latest surveillance data: Hepatitis B & Hepatitis C are the primary sources of data used for this measure.

Comparable international data are not available for this measure.

Data caveat:

Data related to notifiable diseases are generally of a high quality in Australia. However, data related to Indigenous status are only available from the following jurisdictions, and caution is therefore advised in the interpretation of these data as they may not be nationally representative:

Hepatitis B: Australian Capital Territory, Northern Territory, Queensland, South Australia, Tasmania, Victoria and Western Australia.
Hepatitis C: Australian Capital Territory, Northern Territory, Queensland, South Australia, Tasmania, Victoria and Western Australia.

Note that data are only reported for the above jurisdictions if more than 50% of Indigenous status is reported for each reporting year.

References

Activity in this area

Data:

Australian Government Department of Health. National Notifiable Disease Surveillance System. Available here: www9.health.gov.au/cda/source/cda-index.cfm

The Kirby Institute for infection and immunity in society: Surveillance: http://kirby.unsw.edu.au/surveillance

The Kirby Institute Latest Surveillance Data: Hepatitis B and Hepatitis C

Australian Institute of Health and Welfare 2021. Cancer in Australia 2021. Cancer series no. 133. Cat. no. CAN 144. Canberra: AIHW. https://www.aihw.gov.au/reports/cancer/cancer-in-australia-2021/summary

Policy:

Australian Government Department of Health. Fifth National Hepatitis C Strategy
2018-2022. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-bbvs-1//$File/Hep-C-Fifth-Nat-Strategy-2018-22.pdf

Australian Government Department of Health. Third National Hepatitis B Strategy
2018-2022. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-bbvs-1//$File/Hep-B-Third-Nat-Strategy-2018-22.pdf

References

American Cancer Society 2016. Liver Cancer Risk Factors. Available from: https://www.cancer.org/cancer/liver-cancer/causes-risks-prevention/risk-factors.html (accessed 1 February 2019).
Cancer Council Victoria. Hepatitis & liver cancer. Available from: www.cancervic.org.au/for-health-professionals/community-health-professionals/hepatitis-b-and-liver-cancer (accessed 1 February 2019).
Amin J et al. 2006. Cancer incidence in people with hepatitis B or C infection: a large community-based linkage study. J Hepatol. 45(2):197-203.
Cancer Council Australia. National Cancer Control Policy – Liver Cancer. Available at: http://wiki.cancer.org.au/policy/Liver_cancer (accessed 1 February 2019).
Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine, Viral Hepatitis Mapping Project National Report 2020. Sydney, 2021. Available at: https://www.ashm.org.au/resources/hcv-resources-list/viral-hepatitis-mapping-project-national-report-2020/ (accessed January 2022)
Antonsson A et. al. 2015. Cancers in Australia in 2010 attributable to infectious agents. Aust NZ J Public Health. 39:446-51.
The Kirby Institute 2020. National update on HIV, viral hepatitis and sexually transmissible infections in Australia 2009-2018. The Kirby Institute, UNSW: Sydney, Australia. Available at: https://kirby.unsw.edu.au/report-type/annual-surveillance-reports
The Kirby Institute 2018. Bloodborne viral and sexually transmissible infections in Aboriginal and Torres Strait Islander people: annual surveillance report 2018. Sydney: Kirby Institute, UNSW Sydney; 2018.
The Kirby Institute 2020. Latest Surveillance data: Hepatitis B (interactive data display). Sydney: Kirby Institute, UNSW Sydney; 2020. Available at: https://data.kirby.unsw.edu.au/hepatitis-b (accessed January 2022)

Summary

Notification rates for Hepatitis B and C differed by sexIn 2015 the Hepatitis B notification rates for males were 29 per 100,000 personsn compared to 26 for females. For Hepatitis C, notifications for males (61 per 100,000 persons) were nearly double that for females (31 per 100,000 persons).

Notification rates for Hepatitis B and C have decreased over timeFrom 2006 to 2015  notification rates for Hepatitis B and hepatitis C have both decreased (Hepatitis B from 31 to 28 per 100,000 persons and Hepatitis C from 60 to 46 per 100,000 persons), although rates have remained largely unchanged since 2011.

Hepatitis B notification rates for Aboriginal and Torres Strait Islander peoples have decreased over timeOver the period 2015 to 2019, the age-standardised Hepatitis B notification rate in the Aboriginal and Torres Strait Islander population decreased by over 50%, from 52.7 to 24.5 per 100,000 population. During this same period a decrease of 14%, from 21.3 to 18.3 per 100,000 population was observed in the non-Indigenous population.

Aboriginal and Torres Strait Islanders have a disproportionate burden of Hepatitis C Aboriginal and Torres Strait Islanders represent around 3% of the Australian population and at least 14% of Hepatitis C cases, giving them a disproportionate burden of Hepatitis C when compared with the Australian population overall.

Hepatitis C rates were more than twice as high in males than females across all age groupsNotification rates were more than twice as high in males than females across all age groups; 15-24 years: 47.7 compared to 17.9 per 100,000 persons, 25-39 years: 82.8 compared to 35.9 per 100,000 persons, and 40 plus years: 56.6 compared to 25.4 per 100,000 persons. 

Hepatitis B notifications were highest in Major citiesIn 2019, the notification rate for hepatitis B was highest in Major Cities (26.8 per 100,000 population), and lowest in Regional areas (10.6 per 100,000 persons). 

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Data

Summary

Notification rates for Hepatitis B and C differed by sex

Notification rates for Hepatitis B and C have decreased over time

Hepatitis B notification rates for Aboriginal and Torres Strait Islander peoples have decreased over time

Aboriginal and Torres Strait Islanders have a disproportionate burden of Hepatitis C

Hepatitis C rates were more than twice as high in males than females across all age groups

Hepatitis B notifications were highest in Major cities