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).  

    Charts
    • 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.

      Table caption
      New diagnoses of Hepatitis B and Hepatitis C infection, 2010-2019
    • Notes
      Data sourced from the Kirby Institute’s Latest Surveillance data: interactive data display based on notifications made to the Australian National Notifiable Diseases Surveillance System.
      Table caption
      Hepatitis B and Hepatitis C notification rate per 100,000 population, 2010-2019
    • Notes
      Data sourced from the Kirby Institute’s Latest Surveillance data: interactive data display based on notifications made to the Australian National Notifiable Diseases Surveillance System.
      Table caption
      Hepatitis B and Hepatitis C notification rate per 100,000 population, by remoteness and sex, 2010-2019
    • 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.
      Table caption
      Hepatitis B and Hepatitis C notification rate per 100,000 population, by Indigenous status over time, 2014-2018

    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

    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.

    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.

    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

    1. 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).

    2. 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).

    3. 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.

    4. Cancer Council Australia. National Cancer Control Policy – Liver Cancer. Available at: http://wiki.cancer.org.au/policy/Liver_cancer (accessed 1 February 2019).

    5. 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)

    6. Antonsson A et. al. 2015. Cancers in Australia in 2010 attributable to infectious agents. Aust NZ J Public Health. 39:446-51.

    7. 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

    8. 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.

    9. 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 sex

    In 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 time

    From 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 time

    Over 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 groups

    Notification 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 cities

    In 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).