National Progress Report 2020 Goal: Reduce the rate of hepatitis B-related deaths to 0.48 per 100,000 population

Age-adjusted rate* of hepatitis B-related deaths

Bar chart for years 2010-2020, charting rate per 100,000, Starting at .52 for 2010, eventually dropping to .45 for 2016 and projected upward to .48 by 2020.

Source: CDC WONDER, Multiple Cause of Death Data (1)
*Rates are age-adjusted per 100,000 U.S. standard population in 2000.
†Cause of death is defined as the underlying cause of death or one of the multiple causes of death and is based on the International Classification of Disease, 10th Revision (ICD-10) codes B16, B17.0, B18.0, and B18.1.

Summary of Findings

The age-adjusted hepatitis B-related mortality rate decreased from 0.50 per 100,000 U.S. population in 2014 to 0.45 per 100,000 in 2016. There was a slight non-statistically significant increase to 0.46 deaths per 100,000 in 2017; however, the rate remains below the 2020 goal of 0.48 per 100,000.

The 2020 goal will be met by maintaining or further reducing the current hepatitis B-related death rate.

Further reduction can best be achieved by

  • Increasing the proportion of persons tested for hepatitis B.
  • Increasing the proportion of currently infected persons who are referred for care and who receive appropriate treatment.
  • Developing trainings, technical assistance, and tools for primary-care and other health‑care providers to support implementation of hepatitis B testing and referral to care.
  • Using digital technology and telemedicine models to expand access to specialty health‑care providers.
  • Developing innovative/useful clinical decision support tools that increase implementation of hepatitis B screening, testing, and linkage to care.
  • Conducting cost-benefit analyses to determine how payer policies can be revised to expand access to hepatitis B services.
  • Supporting research and development for new and more effective anti-viral therapies with the goal of identifying a functional cure for hepatitis B.

Technical Notes

Data Sources: CDC WONDER, Multiple Cause of Death Data (1)

Numerator: Number of death records with a report of hepatitis B listed as the underlying or one of multiple causes of death

Denominator: Total U.S. Census population

Indicator Notes: Death certificates are completed for all deaths registered in the United States. Information for death certificates is provided to funeral directors or cremation organizations by attending physicians, medical examiners, and coroners. Death certificates are filed in vital statistics offices within each state and the District of Columbia. Through the NVSS, information from death certificates is compiled by CDC to produce national multiple-cause-of-death data; causes of death are coded in accordance with the International Classification of Diseases, Tenth Revision. (2) National multiple-cause mortality data were obtained and analyzed through CDC WONDER, (1) and those death records with a report of hepatitis B (ICD-10: B16, B17.0, B18.0, or B18.1) listed as the underlying or one of the multiple (e.g., contributing) causes of death in the record were enumerated. Rates were calculated as the number of deaths related to hepatitis B divided by the total U.S. Census population. Rates were standardized to the age distribution of the U.S. standard population in 2000. This year, the age-adjusted mortality rates were calculated directly from CDC WONDER (1) resulting in slight changes to the mortality rates reported previously for 2010-2016.

Goal Setting: The goal of reducing the number of deaths from viral hepatitis B from 1,843 in 2014 to 1,754 in 2020 was set in CDC’s Viral Hepatitis Strategic Plan, 2016-2020pdf icon[PDF – 17 pages], and a similar goal was defined in HHS’s National Viral Hepatitis Action Plan, 2017-2020pdf icon[PDF – 84 pages]external icon. Death counts are susceptible to changes in the distribution of the underlying population, potentially confounding trends over time. As such, for the purposes of this report, a proportional reduction goal was applied to the 2014 rate (0.50 deaths per 100,000 U.S. population) instead of the count. Annual targets assume a constant (linear) rate of change from the observed baseline (2014) to the 2020 goal.

Limitations: Mortality data must be interpreted with caution due to the potential for misclassification of ICD-10 codes on the death record, underrepresentation of certain racial/ethnic populations in U.S. Census data, and underreporting of viral hepatitis as a cause of death on death certificates.

References

  1. Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death 1999-2017 on CDC WONDER Online Database, released December, 2018. Data are from the Multiple Cause of Death Files, 1999-2017, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/mcd-icd10.html on Aug 26, 2019 1:18:46 PM
  2. World Health Organization. International Classification of Diseases, 10th Revision. Geneva: World Health Organization; 1998. Available at: http://www.who.int/classifications/icd/en/external icon