Reviewing hepatitis B virus (HBV)-related mortality in Birmingham (2018-2023): The impact of late diagnosis

Published Date: 13th July 2026

Publication Authors: Santharam. S, Croxford. S

Objectives
Review hepatitis B (HBV)-related deaths in Birmingham to interrogate higher HBV-related mortality rates, understand causes of death and identify areas for improvement in diagnostic and care pathways to reduce preventable deaths.

Study Design
Enhanced surveillance – retrospective review of deaths, with linkage to Office for National Statistics (ONS) mortality database for validation.

Methods
Clinicians submitted data on HBV-related deaths occurring in Birmingham (2018-2023) among adults attending for specialist care in the city. Cause of death was obtained from hospital records linked to ONS data.

Results
Data were submitted on 44 people who died of HBV-related causes; 86% were male. Eighty percent were non-UK-born; 70% were born in countries with intermediate-high HBV prevalence. The majority likely acquired HBV in early life (83%). Median age at HBV diagnosis in the UK was 52 years (interquartile range (IQR): 39-62 years); 72% had cirrhosis at diagnosis. The most common diagnosis setting was secondary care (70%). Median age at death was 59 years (IQR: 46-72 years); the most common causes were liver cancer (50%; n = 22) and end-stage liver disease (23%; n = 10).

Conclusions
Among those dying of HBV-related causes in Birmingham, there were missed opportunities for earlier diagnosis, particularly in primary care. The majority of people who died were migrants and probably acquired HBV in early life, yet most were diagnosed in secondary care, middle-aged and with advanced disease. To achieve public health targets around HBV mortality, testing offer/uptake and linkage to care must be improved, addressing barriers and awareness among at-risk groups and healthcare professionals.

Santharam, S; Croxford, S et al. (2026). Reviewing hepatitis B virus (HBV)-related mortality in Birmingham (2018-2023): The impact of late diagnosis. Public Health. 258. [Online]. Available at: https://doi.org/10.1016/j.puhe.2026.106416 [Accessed 23 July 2026]