Hepatitis B and C notifications

Published

28 Jun, 2022

Chronic hepatitis B or C infection is the most common risk factor for liver cancer.¹ Together these diseases are estimated to account for up to 80% of liver cancer cases globally.² Studies have shown 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 projected 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 been increasing over time, from 2 deaths per 100,000 persons in 1980 to a projected rate of 7.4 per 100,000 in 2021. Combined data from jurisdictions selected as sufficiently reporting Indigenous status indicate that during 2012-2016, the annual age-standardised mortality rate for liver cancer in Aboriginal and Torres Strait Islander people (15.3 per 100,000) was more than double the rate for non-Indigenous Australians (6.3 per 100,000). (See: NCCI Indicator – Mortality)

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Hepatitis B or C

Notes

• Data sourced from the Kirby Institute - Bloodborne viral and sexually transmissible infections in Aboriginal and Torres Strait Islander people: annual surveillance report 2018.
• For more information see about the data.

Hepatitis B and Hepatitis C notification rate per 100,000 population, by sex, 2013-2019
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Hepatitis B or C

Notes

• Data sourced from the Kirby Institute - Bloodborne viral and sexually transmissible infections in Aboriginal and Torres Strait Islander people: annual surveillance report 2018.
• For more information see about the data.

Hepatitis B and C notification rate for Indigenous Australians per 100,000 population by age, 2017
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Hepatitis B or C

Notes

Data sourced from the Kirby Institute - Bloodborne viral and sexually transmissible infections in Aboriginal and Torres Strait Islander people: annual surveillance report 2018.

Indigenous Hepatitis B and Hepatitis C notification rate per 100,000 population, by remoteness
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Hepatitis B

Notes

• Data sourced from the Kirby Institute - Bloodborne viral and sexually transmissible infections in Aboriginal and Torres Strait Islander people: annual surveillance report 2018.
• For more information see about the data.

Hepatitis B notification rate for Indigenous Australians per 100,000 population, by age 2013-2017
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Notes

• Data sourced from the Kirby Institute - Bloodborne viral and sexually transmissible infections in Aboriginal and Torres Strait Islander people: annual surveillance report 2018.
• For more information see about the data.

Hepatitis C notification rate for Indigenous Australians per 100,000 population, by age 2013-2019

About this measure

In Australia, the prevalence of chronic hepatitis B is approximately 0.9% and hepatitis C is approximately 0.05% of the population,⁵ with Aboriginal and Torres Strait Islander people having an incidence rate more than three times higher than the non-Indigenous population.⁶ There are multiple risk factors associated with acquiring hepatitis B, including injecting drug use and having unprotected sex, although most Australians living with chronic hepatitis B acquired infection at birth or in early childhood.⁷ Childhood immunisation 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).

Aboriginal and Torres Strait Islander people have higher rates of risk factors for hepatitis C infection, including incarceration and sharing syringes. In 2017, one in four Indigenous people attending needle and syringe programs reported sharing syringes.⁸

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.

Current status

While Aboriginal and Torres Strait Islander people comprise up to 3% of the Australian population, they accounted for a disproportionate number of hepatitis B and hepatitis C notifications in 2017.⁹

Data for hepatitis B and hepatitis C notifications by Indigenous status are available from only a limited number of jurisdictions, and therefore should be treated with caution as a national indicator (refer to About the Data).

Hepatitis B

At the end of 2018, it was estimated that 226,566 Australians were living with chronic hepatitis B and that 23% (52,211) of them were Aboriginal and Torres Strait Islander people.¹⁰

In 2019, there were 5,840 new notifications of hepatitis B infection in Australia. About 2.2% were notified in Aboriginal and Torres Strait Islander people (134 notifications).¹¹

In 2018 the Hepatitis B notification rate for Aboriginal and Torres Strait Islander people was about 1.5 times as high as for non-Indigenous Australians (27 per 100,000 compared with 18 per 100,000 respectively). Nonetheless, this represented a 40% reduction in notification rate since 2014 in the Aboriginal and Torres Strait Islander community.¹⁰

In 2019, notification rates for males were almost two times higher than for females (32 per 100,000 compared to 18 per 100,000).⁸

The highest rate of notifications was observed in the age group over 40 years (58 per 100,000 in 2017).⁸

Remoteness

Notification rates were about four times higher for Aboriginal and Torres Strait Islander people residing in Remote and Very Remote areas (66 per 100,000) compared to those residing in Major cities (16 per 100,000).⁸

Hepatitis C

Aboriginal and Torres Strait Islander people comprise up to 3% of the Australian population, but about 14% (1,315 of 9,230) of newly reported cases of hepatitis C in 2019. It should be noted that Indigenous status notification rates in 2019 included 3,554 (39%) notifications not reporting Indigenous status.¹¹

In 2019 the hepatitis C notification rate for Aboriginal and Torres Strait Islander people (198.6 per 100,000) was about six times higher that of non-Indigenous Australians (31 per 100,000). There were 1,315 hepatitis C notifications among the Aboriginal and Torres Strait Islander population in 2019, about 15% fewer than the 1,113 for 2015.¹⁰

Just over two thirds of hepatitis C notifications for Aboriginal and Torres Strait Islanders in 2019 were for males (282 per 100,00 and 115 per 100,000 for females).¹¹ The highest notification rate applied to the 25-39 age range (385 per 100,000 in 2017).⁸

Remoteness

Notification rates were about six times higher for Aboriginal and Torres Strait Islander people residing in Major Cities (266 per 100,000) compared to those residing in Remote and Very Remote areas (46 per 100,000). Notably, while Aboriginal and Torres Strait Islander people in Major Cities had notification rates eight times higher than for non-Indigenous Australians (266 per 100,000 compared with 33 per 100,000), the difference in notification rates by Aboriginal and Torres Strait Islander status was comparatively minor in Remote and Very Remote areas (46 per 100,000 compared with 32 per 100,000 respectively).⁸

Trends

Hepatitis B

During 2014–2018, the age‑standardised notification rate of hepatitis B decreased by 40% from 45 per 100,000 in 2014 to 27 per 100,000 in 2018, with Indigenous Australians having consistently higher notification rates than non-Indigenous counterparts.¹⁰

During 2013–2017, the notification rate for males decreased by 37% from 102 per 100,000 in 2013 to 64 per 100,000 in 2017. Notifications for females also decreased, by about 44% from 48 per 100,000 to 27 per 100,000.⁸

The hepatitis B notification rate decreased in all age groups during 2013–2017. The highest rate in this period was observed in ages of 40 years, although decreasing by about 41% from 98 to 58 notifications per 100,000 over this period.⁸

Remoteness

During 2013–2017, Aboriginal and Torres Strait Islander people residing in Remote and Very Remote areas had the highest notification rates, although declining from 112 to 66 per 100,000, whereas Major Cities recorded the lowest notification rate, reducing from 21 to 16 per 100,000. Decreases in notification rates were recorded during this period of 24% for Major Cities, 25% for Inner and Outer regional areas, and 41% in Remote and Very Remote areas.⁸

Hepatitis C

During 2015–2018, the age‑standardised notification rate of hepatitis C decreased from 174 per 100,000 to 164 per 100,000. However, the rate among the Aboriginal and Torres Strait Islander population remained relatively stable, reducing by only 6% from 174 notifications per 100 000 in 2015, to 163 per 100 000 in 2018.¹⁰

Notification rates for females remained consistently lower than for males and were steady over this period, albeit with an increase in 2016. The notification rates for males increased during 2013–2015 and then was relatively stable.⁸

In each year during 2013–17, the highest notification rate applied to the age span of 25-39 years, which increased by 23% from 312 to 385 notifications per 100,000 over this period.⁸

Remoteness

During 2013–2017, the notification rate for Aboriginal and Torres Strait Islander people residing in Major Cities decreased marginally (by 7% from 287 to 266 notifications per 100,000), but increased in Inner and Outer Regional and Remote and Very Remote areas by about 37% (from 152 to 208 notifications per 100,000) and by 59% (from 29 to 46 notifications per 100,000).⁸

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 includes both newly acquired and unspecified 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 authority under the provisions of 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 produced by the Kirby Institute for infection and immunity in society, available at www9.health.gov.au/cda/source/cda-index.cfm. The Bloodborne viral and sexually transmissible infections in Aboriginal and Torres Strait Islander people: annual surveillance report 2018, the National update on HIV, viral hepatitis and sexually transmissible infections in Australia, 2009-201810; and The Kirby Institute’s Latest surveillance data: Hepatitis B & Hepatitis C11 are the primary sources of data used for this measure.

Data caveat

Data related to notifiable diseases are generally of a very high quality in Australia. However, data related to Indigenous status are not consistently collected, so only jurisdictions that had at least 50% reporting of Indigenous status in each of the five years in 2013-2017 were included in this report. Caution is advised in the interpretation of these data as they may not be nationally representative:

For hepatitis B notifications, jurisdictions included the Australian Capital Territory, Northern Territory, South Australia, Tasmania and Western Australia. Approximately one-third (33%) of the identified Aboriginal and Torres Strait Islander population reside in these jurisdictions.
For hepatitis C notifications, jurisdictions included the Northern Territory, Queensland, South Australia, Tasmania, and Western Australia. Almost two-thirds (61%) of the identified Aboriginal and Torres Strait Islander population reside in these jurisdictions.

2018 data reported in this indicator are based on data from six jurisdictions (The Australian Capital Territory, Northern Territory, Queensland, South Australia, Tasmania and Western Australia) where the reporting of Aboriginal and Torres Strait Islander status was estimated to be at least 50% complete for hepatitis B and C notifications for each of the reported five years of 2014–2018. New South Wales and Victoria were excluded from the analyses due to low reporting of Indigenous status.

2019 data for Hepatitis B and Hepatitis C notifications, jurisdictions include: Australian Capital Territory, Northern Territory, Queensland, South Australia, Tasmania, Victoria and Western Australia. Where 2019 data is available, previous years data has been updated, this may alter previously reported numbers as additional jurisdictions can now be reported on. 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 from: https://www1.health.gov.au/internet/main/publishing.nsf/Content/ohp-pub-datasets.htm

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

The Kirby Institute. Bloodborne viral and sexually transmissible infections in Aboriginal and Torres Strait Islander People: Annual surveillance report 2018. University of NSW, Sydney. Available from: https://kirby.unsw.edu.au/sites/default/files/kirby/report/KI_Aboriginal-Surveillance-Report-2018.pdf

The Kirby Institute. National update on HIV, viral hepatitis and sexually transmissible infections in Australia, 2009-2018. Sydney: Kirby Institute, Sydney, 2020. Available from: https://kirby.unsw.edu.au/sites/default/files/kirby/report/National-update-on-HIV-viral-hepatitis-and-STIs-2009-2018.pdf

Policy:

Australian Government Department of Health. Fifth National Aboriginal and Torres Strait Islander Blood Borne Viruses and Sexually Transmissible Infections Strategy 2018–2022. Available from: https://www1.health.gov.au/internet/main/publishing.nsf/Content/ohp-bbvs-1//$File/ATSI-Fifth-Nat-Strategy-2018-22.pdf

Australian Government Department of Health. National Aboriginal and Torres Strait Islander Health Plan 2013–2023. Available from: https://www.health.gov.au/resources/publications/national-aboriginal-and-torres-strait-islander-health-plan-2013-2023

Australian Government Department of Health. The new National Aboriginal and Torres Strait Islander Health Plan 2021-2031. Available from: https://www.health.gov.au/resources/publications/national-aboriginal-and-torres-strait-islander-health-plan-2021-2031

References

1. American Cancer Society 2019. Liver Cancer. Available from: https://www.cancer.org/cancer/liver-cancer/causes-risks-prevention/risk-factors.html (accessed December 2021).

2. Cancer Council Victoria. Hepatitis B & liver cancer. Available from: www.cancervic.org.au/for-health-professionals/community-health-professionals/hepatitis-b-and-liver-cancer (accessed December 2021).

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: https://wiki.cancer.org.au/policy/Liver_cancer (accessed December 2021).

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. 2015; 39:446-51.

7. Kirby Institute. Bloodborne viral and sexually transmissible infections in Aboriginal and Torres Strait Islander people: annual surveillance report 2017. Sydney: Kirby Institute, UNSW Sydney; 2017.

8. Kirby Institute 2018. Bloodborne viral and sexually transmissible infections in Aboriginal and Torres Strait Islander people: annual surveillance report 2018. Kirby Institute, UNSW: Sydney, Australia

9. Hepatitis Australia. Hepatitis Statistics. Available at: https://www.hepatitisaustralia.com/hepatitis-statistics (accessed December 2021)

10. The Kirby Institute. National update on HIV, viral hepatitis and sexually transmissible infections in Australia, 2009-2018. Sydney: Kirby Institute, Sydney, 2020. Available from: https://kirby.unsw.edu.au/sites/default/files/kirby/report/National-update-on-HIV-viral-hepatitis-and-STIs-2009-2018.pdf (accessed January 2022)

11. The Kirby Institute 2020. Latest Surveillance data: Hepatitis B & Hepatitis C (interactive data display). Sydney: Kirby Institute, UNSW Sydney; 2020. Available at: https://data.kirby.unsw.edu.au/hepatitis-b (accessed January 2022)

Summary

Hepatitis BIn 2018, the Hepatitis B notification rate for Aboriginal and Torres Strait Islander people was 1.5 times the rate for non-Indigenous Australians (27 per 100,000 and 18 per 100,000 respectively. In 2017, notification rates for males were over two times higher than for females (64 per 100,000 compared to 27 per 100,000).

In 2017, the notification rate was approximately four times higher for Aboriginal and Torres Strait Islander people residing in Remote and Very Remote areas of Australia (66 per 100,000) compared to those residing in Major cities (16 per 100,000).

The rate of hepatitis B notifications showed a decrease across almost all age groups during the 2013-2019 period.

Hepatitis CAboriginal and Torres Strait Islander people comprise up to 3% of the Australian population but accounted for at about 14% (1,315 of 9,230) of newly reported notified cases of Hepatitis C in 2019. 
Approximately two thirds of hepatitis C notifications in 2019 were for males (68%). 
Notification rates were almost six times higher for Aboriginal and Torres Strait Islander people residing in Major Cities (266 per 100,000) compared to those residing in Remote and Very Remote areas (46 per 100,000).
During each the 2013–17 period, the highest rate of notifications of Hepatitis C applied to the 25-39-year age range, which increased by 23% from 312 to 385 notifications per 100,000 over that period.

Revision Type

Major

Version Number

1.0.0

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Data

Summary

Hepatitis B

Hepatitis C