Trends and Future Projections of Liver Cirrhosis Burden in Sub-Saharan Africa with Hepatitis B Vaccination Impact

Liver cirrhosis and chronic liver diseases impose a substantial and growing health burden globally, with sub-Saharan Africa (SSA) disproportionately affected. Leveraging Global Burden of Disease 2021 data and Bayesian hierarchical models, we quantified mortality and disability trends in SSA from 1990 to 2021 and projected disease burden through 2035, incorporating scenarios for hepatitis B vaccination scale-up. In 2021, liver cirrhosis accounted for an estimated 181,311 deaths in SSA, despite a 29% decline in age-standardized death rates (ASDR) since 1990. Absolute deaths increased by 65%, predominantly driven by hepatitis B (37%), hepatitis C (28%), and alcohol-related cirrhosis (17%). Disability-adjusted life years (DALYs) surged by 76%, from approximately 1.05 million in 1990 to 1.85 million in 2021, highlighting rising absolute disability alongside a 29% reduction in age-standardized DALYs. Mortality and disability burdens were highest in Somalia, Central African Republic, and Guinea-Bissau. Males bore nearly twice the burden of females. While death rates declined across all socio-demographic strata, absolute deaths rose by 55-86%. Projections to 2035 suggest further potential reductions in mortality from hepatitis B (up to 21.5%), hepatitis C (up to 18.7%), and alcohol-related cirrhosis, while the burden of non-alcoholic fatty liver disease is expected to remain stable or increase slightly. Scaling up hepatitis B vaccination could further avert 27% of related deaths by 2035. These findings reveal persistent and widening disparities in cirrhosis burden across SSA, underscoring the urgent need for integrated, context-specific interventions combining viral hepatitis control with metabolic liver disease management to improve equitable liver health outcomes.