Skip to main content

Disease burden of hepatitis E in a rural population in China: a community-based survey

  • H. JIANG (a1), S. HUANG (a2), Y. ZHAO (a3), Y. WANG (a1), C. YANG (a1), J. CAI (a1), Z. WANG (a1), J. ZHANG (a2), X. ZHANG (a4) and H. JIN (a3)...

This study aimed to estimate the disease burden of hepatitis E in a rural region in China. A total of 489 hepatitis E cases were reported according to a community-based survey in an active hepatitis surveillance system between 2008 and 2015, the questionnaire and record-review methods were constructed to evaluate the economic and health burden of hepatitis E virus infections from societal perspectives. All costs were converted to US$ in 2015. The age-standardized cumulative incidence rate was 107·9/100 000, and the median age-standardized annual incidence rate was 16·5/100 000. The median direct, indirect, and intangible cost were $1046·0, $49·1, and $77·3/patient, respectively, and the median economic burden per patient was $1836·5, which accounted for 51·2% of per capita disposable income. Moreover, the median quality-adjusted life year and visual analogue scale score were 0·7 and 70·0/case, respectively. Both economic burden and health burden of inpatients was more serious than that of outpatients (P < 0·001). Disease burden of hepatitis E is heavy on patients, their families, and society. More studies on the disease burden of hepatitis E are necessary to increase social awareness of the disease and confirm reasonable disease-control measures.

Corresponding author
*Author for correspondence: Mr X. Zhang, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China. (Email:
Hide All
† These authors contributed equally to this work.
Hide All
1. Hamid, SS, et al. Fulminant hepatic failure in pregnant women: acute fatty liver or acute viral hepatitis? Journal of Hepatology 1996; 25: 2027.
2. Banait, VS, et al. Outcome of acute liver failure due to acute hepatitis E in pregnant women. Indian Journal of Gastroenterology 2007; 26: 610.
3. Khuroo, MS. Hepatitis E: an emerging global disease – from discovery towards control and cure. Journal of Viral Hepatitis 2016; 23: 6879.
4. Mirazo, S, et al. Transmission, diagnosis, and management of hepatitis E: an update. Hepatic Medicine: Evidence and Research 2014; 6: 4559.
5. Rein, DB, et al. The global burden of hepatitis E virus genotypes 1 and 2 in 2005. Hepatology 2012; 55: 988997.
6. Conteh, L, Engels, T, Molyneux, DH. Socioeconomic aspects of neglected tropical diseases. Lancet 2010; 375: 239247.
7. Wu, T, et al. Hepatitis E vaccine development A 14-year odyssey. Human Vaccines & Immunotherapeutics 2012; 8: 823827.
8. Xiu, SX. Disease burden of hepatitis E and health economic evaluation of vaccine interventions in Dongtai Area. Southeast University, 2011.
9. Jiang, M, et al. Economic burden of patients with hepatitis E and influencing factors in Yantai city, China. Chinese Journal of Epidemiology 2011; 32: 845846.
10. Zhu, FC, et al. Efficacy and safety of a recombinant hepatitis E vaccine in healthy adults: a large-scale, randomised, double-blind placebo-controlled, phase 3 trial. Lancet 2010; 376: 895902.
11. Zhu, FC, et al. Epidemiology of zoonotic hepatitis E: a community-based surveillance study in a rural population in China. PLoS ONE 2014; 9: e87154.
12. Xie, Z, et al. Posthospital discharge medical care costs and family burden associated with osteoporotic fracture patients in China from 2011 to 2013. Journal of Osteoporosis 2015; 25: 16.
13. Tarricone, R. Cost-of-illness analysis. What room in health economics? Health Policy 2006; 77: 5163.
14. Ogwulu, CB, et al. Exploring the intangible economic costs of stillbirth. BMC Pregnancy and Childbirth 2015; 15: 188.
15. Wundes, A, et al. Contribution of intangible costs to the economic burden of multiple sclerosis. Journal of Medical Economics 2010; 13: 626632.
17. The EuroQol Group. EQ-5D-3L user guide: basic information on how to use the EQ-5D-3L instrument, 2015.
18. Tsuchiya, A, et al. Estimating an EQ-5D population value set: the case of Japan. Health economics 2002; 11: 341353.
19. Zhang, M, et al. Analysis on morbidity and mortality of viral hepatitis in China, 2004–2013. Chinese Journal of Epidemiology 2015; 36: 144147.
20. Anon. Hepatitis E vaccine: WHO position paper, May 2015. Weekly Epidemiological Record 2015; 90: 185200.
21. Zhang, J, et al. Long-term efficacy of a hepatitis E vaccine. New England Journal of Medicine 2015; 372: 914922.
22. Pan, J, et al. Benefit distribution of social health insurance: evidence from China's urban resident basic medical insurance. Health Policy and Planning 2016.
23. Meng, Q, et al. Consolidating the social health insurance schemes in China: towards an equitable and efficient health system. Lancet 2015; 386: 14841492.
24. Mahmood, MA, et al. Cooperative medical insurance and the cost of care in Shandong, PR China: perspectives of patients and community members. Asia-Pacific Journal of Public Health 2015; 27: 897902.
25. Kamar, N, et al. Hepatitis E. Lancet 2012; 379: 24772488.
26. Jia, Z, et al. Epidemiology of hepatitis E virus in China: results from the Third National Viral Hepatitis Prevalence Survey, 2005–2006. PLoS ONE 2014; 9: e110837.
27. Jin, H, et al. Comparison between EQ-5D and SF-6D utility in rural residents of Jiangsu Province, China. PLoS ONE 2012; 7: e41550.
28. Jia, YX, et al. Comparison between the EQ-5D-5L and the EQ-5D-3L in patients with hepatitis B. Quality of Life Research 2014; 23: 23552363.
29. Steinke, DT, et al. Epidemiology and economic burden of viral hepatitis: an observational population based study. Gut 2002; 50: 100105.
30. Shon, C, et al. The economic burden of hepatitis A, B, and C in South Korea. Japanese Journal of Infectious Diseases 2016; 69: 1827.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 3
Total number of PDF views: 77 *
Loading metrics...

Abstract views

Total abstract views: 403 *
Loading metrics...

* Views captured on Cambridge Core between 19th January 2017 - 14th August 2018. This data will be updated every 24 hours.