Late Diagnosis of Hepatitis B and C Remains a Global Challenge

A new systematic review is highlighting persistent barriers to the timely diagnosis of chronic hepatitis B (HBV) and hepatitis C (HCV), underscoring missed opportunities for early intervention in diseases that often remain silent until advanced stages.¹

The findings point to a need for more targeted and proactive screening strategies, particularly for high-risk groups, including older individuals, men, those with diabetes, and individuals with a history of alcohol misuse. Integrating hepatitis screening into routine care for these populations could help identify infections earlier and improve outcomes, they argue.

The study, published in Health Science Reports, synthesized data from 22 studies examining factors that contribute to delayed diagnosis of viral hepatitis, conditions that collectively affect hundreds of millions of people worldwide and are a leading cause of liver-related morbidity and mortality. Much of the burden stems from late diagnosis, when patients first present with advanced complications such as cirrhosis or hepatocellular carcinoma.

The review found that late diagnosis remains common, with rates ranging from 11% to 70% for hepatitis C and 15% to 51% for hepatitis B across the included studies. Previous data have pointed to reductions in delayed hepatitis diagnoses, with one study showing a decrease from nearly 90% in 2015 to 75% in 2021,² and the current study identified several regions that have seen improvements over time; however, a substantial proportion of cases are still identified only after significant liver damage has occurred.

The consequences of late diagnosis are substantial, as patients diagnosed at advanced stages face significantly higher rates of hospitalization and mortality. Some studies included in the review reported up to 4-fold increases in mortality among patients diagnosed late, reinforcing the critical importance of early detection and intervention.

One of the central challenges in detecting viral hepatitis early is its often asymptomatic nature. Patients can live with chronic infection for decades without noticeable symptoms, leading many to seek care only after complications arise. This silent progression, wrote the researchers, contributes to delayed diagnosis and worsened outcomes.

The analysis identified several key demographic and clinical factors associated with late diagnosis. Older age emerged as one of the most consistent risk factors across both hepatitis B and C. Individuals over 40 years old were significantly more likely to be diagnosed at a later stage, potentially due to age-related immune changes and cumulative disease progression.

Gender also played a role, with men being more likely than women to experience delayed diagnosis, a finding that researchers suggest may be linked to differences in healthcare utilization, as men tend to engage less frequently with healthcare services, reducing opportunities for early detection.

The researchers also highlighted how biological differences may play a role. They wrote: “Biological sex significantly affects immune response, influencing the development and progression of viral hepatitis in men and women. Females typically exhibit stronger innate, humoral, and cellular immune reactions compared to males. Estrogen generally stimulates the immune system, while androgens suppress it, contributing to differences in how viral hepatitis progresses, and may explain why men are predominantly diagnosed later than women.”

Lifestyle and comorbidity factors further influenced diagnostic timing. A history of alcohol misuse was strongly associated with late diagnosis, likely due to its role in accelerating liver damage and masking underlying disease. Similarly, diabetes mellitus was identified as a contributing factor, particularly in hepatitis C, where it is linked to faster disease progression and poorer outcomes.

Healthcare access and engagement also emerged as critical determinants. Patients with fewer physician visits were significantly more likely to be diagnosed late, while those with regular healthcare interactions were more likely to receive timely diagnoses, highlighting that routine check-ups and higher outpatient utilization can play a pivotal role in early detection.

Conversely, several factors were associated with earlier diagnosis. In addition to women, individuals with a history of injection drug use and patients co-infected with HIV were more likely to be diagnosed earlier. In these cases, targeted screening programs and increased interaction with healthcare systems, such as routine testing in high-risk populations, appeared to improve detection rates.

The study also spotlighted the impact of social and structural determinants. Immigrant populations may face unique barriers, including language differences, cultural stigma, and limited access to healthcare services, which can delay diagnosis. At the same time, in some contexts, immigrant status was linked to earlier detection due to targeted screening efforts.

While the study provides valuable insights, it also notes limitations, including geographic gaps in the data and variability in study designs.

References

1. Ibegu M, Keakabetse T, Tuan Nguyen AL, Stephens N, de Graaff B. A systematic review and narrative synthesis of factors impacting late diagnosis of chronic hepatitis B and C. Health Sci Rep. Published online March 8, 2026. doi:10.1002/hsr2.71975

2. Levesley CR, Zhang X, Manikat R, Cheung RR, Nguyen MH. Delayed diagnosis of hepatitis C infection: Results of a nationwide US study. Dig Dis. 2025;43(6):667-677. doi:10.1159/000548379.