Chronic hepatitis B and C infections are the most common risk factors for liver cancer globally, accounting for an estimated 80% of all liver cancers.1 Primary liver cancer is the sixth most commonly diagnosed cancer and was rated the third leading cause of cancer death worldwide in 2020.2Studies 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
In 2023 in Australia, the estimated number of new cases of liver cancer diagnosed was 3,048, with an age-standardised mortality rate of 9.7 deaths per 100,000 persons.4 (age standardised rates are standardised to the 2023 Australian Standard Population)
About this measure
Hepatitis B and hepatitis C infections are main risk factors for Hepatocellular carcinoma development.5,6
Hepatitis B is a common blood borne virus (BBV) in Australia and a leading cause of primary liver cancer.7-8 Hepatitis B among adolescents and adults in Australia is transmitted through a variety of pathways, including injecting drug use and sexual contact. Seventy-two per cent of people living with chronic hepatitis B in Australia are either from cultural and linguistically diverse (CALD) backgrounds or are Aboriginal and Torres Strait Islander people who likely acquired hepatitis B at birth or in early childhood.8
Australia has made significant advances in containing hepatitis B infection rates in recent years through high vaccination coverage (note: through early childhood and catchup vaccination programs as well as vaccination of adults at elevated risk of hepatitis B infection). Nonetheless this infection remains a serious public health challenge. Efforts are needed to ensure high rates of diagnosis and treatment. Of people living with chronic hepatitis B in Australia (2021 data), an estimated 27.5% were undiagnosed and 12.7% receiving treatmtent.7
Australia is working towards eliminating hepatitis C as a public health threat by 2030, which is in line with global targets set by the World Health Organization (WHO) and targets included in Australia’s National Hepatitis C Strategy 2018–2022 and 2023–2030.9-10 Considerable progress has been made in recent years with health promotion campaigns undertaken to raise awareness of the need for testing and with increased availability and access to curative hepatitis C treatments. Injecting drug use, particularly receptive needle and syringe sharing is the major route of hepatitis C transmission.9-10 People who inject drugs are a key population for hepatitis C treatment and prevention. Among participants of the Australian Needle Syringe Program Survey, treatment uptake has increased markedly, resulting in a substantial reduction in the prevalence of active hepatitis C infection in this group.11
Current status
Hepatitis B notifications 12,15
In 2022, there was a total of 5075 hepatitis B notifications in Australia, with more than half (53%, 2698) occurring in males, as compared with 2355 (46%) in females). The notification rate for hepatitis B in 2022 was 19.3 cases per 100,000 persons, with a higher rate in males (20.8 cases per 100,000) than females (17.8 cases per 100,000).
Aboriginal and Torres Strait Islander peoples
Data for hepatitis B notifications by Indigenous status are only available for a limited number of jurisdictions, which may not be entirely representative nationally. (Refer to “Data caveat”). In 2022, the hepatitis B notification rate among Aboriginal and Torres Strait Islander peoples in these jurisdictions was about 30% higher than among the non‑Indigenous population (19.0 vs 14.6 per 100 000, respectively).
The hepatitis B notification rate was higher among Indigenous males (25.1 per 100,000) than females (13.4 per 100,000). Note that there were 2210 (43.5%) notifications for which Aboriginal and Torres Strait Islander status was not reported in 2022 which likely affected overall notification rates.
Remoteness
In 2022, Hepatitis B notification rates were higher among residents of Major cities and Remote areas (at 22.5 and 15.4 per 100,000, respectively) than in Regional areas (at 9.6 per 100,000).
Hepatitis C notifications13,16
In 2022, a total of 6728 hepatitis C notifications was reported in Australia (25.8 per 100,000), of which over two‑thirds (4659, 69.2%) were for males. The notification rate in males was more than double that in females (36.2 vs 15.5 per 100,000). The hepatitis notification rate among peoples aged 15 to 24 years (used as a proxy indicator for incidence of hepatitis C) was 21.1 per 100,000.
Aboriginal and Torres Strait Islander peoples
In 2022, the notification rate among Aboriginal and Torres Strait Islander peoples was more than seven times the rate for non‑Indigenous people (i.e., 156.2 versus 21.7 per 100,000, respectively). The hepatitis C notification rate in Aboriginal and Torres Strait males more than doubled the rate in females (216.2 versus 95.5 per 100,000).
The hepatitis notification rate among Aboriginal and Torres Strait Islander peoples aged 15 to 24 years was approximately 10 times the corresponding rate for non‑Indigenous people (188.5 vs 18.3 per 100,000). Of note, a further 2419 (36%) were among people whose Indigenous status was not reported.
Remoteness
In 2022, notification rates of hepatitis C appeared to be marginally higher in Regional areas (34.0 per 100,000) than Remote areas (30.6 per 100,000), which were both higher than for Major cities (20.9 per 100,000).
Trends
The notification rates for hepatitis B and hepatitis C have both decreased over time from 28.8 and 44.6 cases per 100,000 population respectively in 2013 to 19.3 and 25.8 cases per 100,000 population in 2022.8,11
Hepatitis B 12,15
There have been declines in the hepatitis B notification rate between 2013 and 2022 from 28.8 to 19.3 per 100, 000. The declines between 2019 and 2021 were followed by a slight increase in 2022 from 18.4 in 2021 to 19.3 per 100,000 in 2022. Factors affecting trends would include vaccination coverage, as well as COVID‑19 impacts on migration, healthcare access and testing, and travel during 2020 and 2021. The decline has been observed in both males and females (from 32.5 and 24.9 in 2013 to 20.8 and 17.8 per 100,000 in 2022, respectively), with notification rates being consistently higher among males than females,
Aboriginal and Torres Strait Islander peoples
The notification rate among Aboriginal and Torres Strait Islander peoples (note: in the reported jurisdictions) declined between 2018 and 2022 from 29.4 to 19.0 per 100,000. The decrease was observed in both males and females, from 37.4 and 25.1 per 100,000 in 2018 to 25.1 and 13.4 per 100,000 respectively in 2022.
Remoteness
Notification rates between 2013 to 2022 declined in Major cities from 32.5 to 22.5 per 100,000, and from 16.0 to 9.6 per 100,000 in Regional areas. Although fluctuating in Remote areas, there was also an overall decrease from 36.1 to 15.4 per 100,000 in this period.
The pattern of decline was similar among males and females, with notification rates being lowest in Regional areas for both sexes.12,15
Hepatitis C 13,16
The overall hepatitis C notification rate declined over the period 2013 to 2022, from 44.6 to 25.8 per 100,000 population. This is consistent with the uptake of hepatitis C treatment resulting in a decline of hepatitis C transmission.
Notification rates have been gradually decreasing among both males and females since 2013 despite an increase in 2015-2016. The decrease was significant since 2016 which likely reflected the increase in testing associated with government‐funded interferon‐free direct‐acting antiviral treatments becoming available on the PBS.9-14 Since 2016, when there was a rapid uptake of treatment and cure among people living with hepatitis C, a steady reduction in notification rates took place.
Between 2019 and 2021, the decline in hepatitis C notifications was also affected by COVID‑19, which created challenges in accessing testing and healthcare in this period.
Aboriginal and Torres Strait Islander peoples
Over the period 2018-2022, the age-standardised Hepatitis C notification rate in the Aboriginal and Torres Strait Islander population reduced from 186.0 to 156.2 per 100,000 population. Hepatitis C notification rates were consistently higher in Indigenous males than Indigenous females. Similarly, this rate was consistently higher in Aboriginal and Torres Strait Islander males and females than their non-Indigenous counterparts.
Remoteness
Between 2016 and 2022, notification rates declined in all remoteness areas collectively from 43.9 to 20.9 per 100,000 in Major cities, from 69.3 to 34.0 in Regional areas, and from 48.1 to 30.6 per 100,000 in Remote areas. Hepatitis C notification rates have historically been higher in Regional areas than in Remote areas and Major cities.
There was an increase in all remoteness areas in the Hepatitis C notification rate in 2015 and 2016 and a fluctuation between 2013 and 2015. In Remote areas, the notification rates fluctuated in 2019-21, reflecting COVID-19 effects in these areas.
Between 2013 and 2022, notification rates declined among males from 50.3 to 27.9 per 100,000 in Major cities, from 71.0 to 50.7 per 100,000 in Regional areas, and from 65.0 to 39.9 per 100,000 in Remote areas. In the same period, among females, the notification rate declined from 28.1 to 14.1 per 100,000 in Major cities, from 38.1 to 17.1 per 100,000 in Regional areas, and from 34.7 to 20.4 per 100 000 in Remote areas.
About the data
This measure indicates the number of notifications per 100,000 population of people newly diagnosed with hepatitis B or hepatitis C in Australia, including both newly acquired (i.e., within two years before diagnosis) and unspecified (i.e., those not meeting ‘newly acquired’ criteria and acquired more than two years before diagnosis).
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.
New notifications of viral hepatitis (hepatitis B and C) are notifiable conditions in all state/territory health jurisdictions in Australia. Cases were notified by the diagnosing laboratory, medical practitioner, hospital, or a combination of these sources, through state/territory health authorities, to the National Notifiable Diseases Surveillance System (NNDSS).17
Age‑standardised notification rates were calculated using population denominators obtained from the Australian Bureau of Statistics (ABS) estimated residential population by state, year, gender, and age (ABS series 3101051‑3101058) and were standardised using ABS Standard Population data (31010DO003_200106 Standard Population for Use in Age Standardisation).17
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/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 of relevance to this measure are provided in annual surveillance reports, and in interactive latest surveillance data produced by the Kirby Institute for infection and immunity in society.12-13,15-17
Published data are available from the National update on HIV, viral hepatitis and sexually transmissible infections in Australia 2022; and the Latest surveillance data: Hepatitis B & Hepatitis C from Kirby Institute.15-16
Data caveat:
Data are limited to 5 jurisdictions for which Aboriginal and Torres Strait Islander status was ≥50% complete for all hepatitis notifications for each of the five years for 2018–2022. Caution is needed in the interpretation of these data as they may not be nationally representative. Incomplete information on Aboriginal and Torres Strait Islander status can underestimate the true extent of these infections among Aboriginal and Torres Strait Islander peoples and notification rates may not fully reflect national trends.
The hepatitis B&C notification rate among Aboriginal and Torres Strait Islander peoples is based on data from five jurisdictions (Australian Capital Territory, Northern Territory, Queensland, South Australia, and Western Australia). Approximately 50% of Aboriginal/or and Torres Strait Islander peoples reside in these jurisdictions.12-13
References
Policy:
Australian Government. Department of Health and Aged Care. Fourth National Hepatitis B Strategy 2023–2030 https://www.health.gov.au/sites/default/files/2023-05/fourth-national-hepatitis-b-strategy-2023-2030.pdf
Australian Government. Department of Health and Aged Care. Sixth National Hepatitis C Strategy 2023-2030. Accessed May 2024; https://www.health.gov.au/sites/default/files/2023-05/sixth-national-hepatitis-c-strategy-2023-2030.pdf
Australian Government. Department of Health and Aged Care. Fifth National Hepatitis C Strategy 2018-2022. Accessed May 2024; https://www.health.gov.au/sites/default/files/documents/2022/06/fifth-national-hepatitis-c-strategy-2018-2022.pdf
Australian Government. Department of Health and Aged Care. Third National Hepatitis B Strategy 2018-2022. Accessed May 2024; https://www.health.gov.au/sites/default/files/documents/2022/06/third-national-hepatitis-b-strategy-2018-2022.pdf
Data:
The Kirby Institute Latest Surveillance Data: Hepatitis B and Hepatitis C:
https://data.kirby.unsw.edu.au/hepatitis-b
https://data.kirby.unsw.edu.au/hepatitis-c
Australia Government. Cancer Australia. Liver cancer in Australia statistics. Accessed May 2025; https://www.canceraustralia.gov.au/cancer-types/liver-cancer/statistics.
References
- El-Serag HB. Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterology. 2012 May;142(6):1264-1273.e1.
- Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021 May;71(3):209-249.
- Amin J, Dore GJ, O'Connell DL, et al. Cancer incidence in people with hepatitis B or C infection: a large community-based linkage study. J Hepatol. 2006 Aug;45(2):197-203.
- Australia Government. Cancer Australia. Liver cancer in Australia statistics. Accessed May 2024; https://www.canceraustralia.gov.au/cancer-types/liver-cancer/statistics.
- Llovet, J.M., Kelley, R.K., Villanueva, A. et al. Hepatocellular carcinoma. Nat Rev Dis Primers 7, 6 (2021).
- Zhang X, Guan L, Tian H, et al. Risk Factors and Prevention of Viral Hepatitis-Related Hepatocellular Carcinoma. Front Oncol. 2021 Sep 9;11:686962.
- MacLachlan JH, Romero N, Purcell I, Cowie BC. Viral Hepatitis Mapping Project: Hepatitis B. National Report 2021. Darlinghurst, NSW: Australasian Society for HIV, Viral Hepatitis, and Sexual Health Medicine (ASHM), 2023.Accessed May 2024; https://ashm.org.au/wp-content/uploads/2023/09/Viral-Hepatitis-Mapping-Project_National-Report-Hepatitis-B-2021.pdf
- Australian Government. Department of Health and Aged Care. Third National Hepatitis B Strategy 2018-2022. Accessed May 2024; https://www.health.gov.au/sites/default/files/documents/2022/06/third-national-hepatitis-b-strategy-2018-2022.pdf
- Australian Government. Department of Health and Aged Care. Sixth National Hepatitis C Strategy 2023-2030. Accessed May 2024; https://www.health.gov.au/sites/default/files/2023-05/sixth-national-hepatitis-c-strategy-2023-2030.pdf
- Australian Government. Department of Health and Aged Care. Fifth National Hepatitis C Strategy 2018-2022. Accessed May 2024; https://www.health.gov.au/sites/default/files/documents/2022/06/fifth-national-hepatitis-c-strategy-2018-2022.pdf
- Heard, S; Zolala, F & Maher, L. Australian Needle Syringe Program Survey National Data Report 2018-2022: Prevalence of HIV, HCV and injecting and sexual behaviour among NSP attendees. Sydney: Kirby Institute, UNSW. Accessed May 2024; https://www.kirby.unsw.edu.au/sites/default/files/documents/ANSPS_National-Data-Report-2018-2022.pdf
- The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia Annual surveillance report 2022 - Hepatitis B. The Kirby Institute, UNSW: Sydney, Australia. Accessed May 2024; https://www.kirby.unsw.edu.au/sites/default/files/documents/Annual-Surveillance-Report-2023_HBV.pdf
- The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia Annual surveillance report 2022 - Hepatitis C. The Kirby Institute, UNSW: Sydney, Australia. Accessed May 2024; https://www.kirby.unsw.edu.au/sites/default/files/documents/Annual-Surveillance-Report-2023_HCV_0.pdf
- Valerio H, Alavi M, Silk D, et al. Progress Towards Elimination of Hepatitis C Infection Among People Who Inject Drugs in Australia: The ETHOS Engage Study. Clin Infect Dis. 2021 Jul 1;73(1): e69-e78.
- The Kirby Institute. Latest Surveillance Data - Hepatitis B. The Kirby Institute, UNSW: Sydney, Australia. Accessed May 2024; https://data.kirby.unsw.edu.au/hepatitis-b
- The Kirby Institute. Latest Surveillance Data - Hepatitis C. The Kirby Institute, UNSW: Sydney, Australia. Accessed May 2024; https://data.kirby.unsw.edu.au/hepatitis-c
- The Kirby Institute. Methodology. Accessed May 2024; https://www.kirby.unsw.edu.au/sites/default/files/documents/Annual-Surveillance-Report-2023-Methods.pdf