Our objective was to evaluate the shifting burden of hepatitis E virus (HEV) across age groups and geographical scopes from 1990 to 2021 and to predict incidence rates for 2030. Leveraging data from the Global Burden of Diseases 2021, we examined HEV incidence and disability-adjusted life years, calculated average annual percentage changes (AAPCs) and identified pivotal years for incidence trends. We stratified our analysis by age, sex, and sociodemographic index and employed the Bayesian age-period-cohort model to predict future incidence. HEV incidence decreased from 269.68 per 100,000 in 1990 to 260.41 per 100,000 in 2021, with an AAPC of -0.1. Notably, the incidence significantly decreased in 1995, 2006, 2009, and 2014. Southern sub-Saharan Africa presented the most notable increase in HEV infection incidence, increasing from 218.59 per 100,000 individuals (95% [UI] 181.36 to 262.28) to 232.25 per 100,000 individuals (191.9 to 279.82), with an AAPC of 0.2 (95% [CI] 0.2 to 0.2). The 2030 incidence is projected to be 267.44 per 100,000 (95% UI, 235.27 to 299.6). Despite a general decline in HEV incidence associated with health interventions, some regions still report annual increases, underscoring the need for intensified disease management to meet the 2030 goals.

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