The group of viruses that specifically cause acute liver inflammation, or hepatitis, are no lightweights when it comes to inflicting death and suffering, a new report published Wednesday in The Lancet has found. And its authors believe the findings signal an urgent need to step up our efforts at prevention and treatment.

Examining data from the Global Burden of Disease study, an expansive long-running attempt to quantify health trends worldwide, the researchers tracked how much illness and disability viral hepatitis caused from 1990 to 2013. The collection of viruses — Hepatitis A, B, C, D, and E — were ultimately responsible for 1.45 million deaths in 2013. Not only did this total represent an increase from the 890,000 deaths seen in 1990, it also made viral hepatitis the 7th leading cause of death that year, above other infectious bogeymen like HIV/AIDS, tuberculosis, and malaria. The rates of disability similarly took an upward climb, particularly for Hepatitis C. In comparison, the world’s number one killer, heart disease, took down 8.1 million that same year.

"This is the most comprehensive analysis to date of the global burden of viral hepatitis. And it reveals startling findings — showing the death toll from this condition is now 1.45 million,” said senior author Dr Graham Cooke, a researcher at Imperial College London’s Department of Medicine, in a statement. “Whereas deaths from many infectious diseases — such as TB and malaria — have dropped since 1990, viral hepatitis deaths have risen."

Nearly all of the deaths and disability came from Hepatitis B and C, both of which are transmitted via exposure to contaminated blood and often lead to chronic liver problems, whereas the improved global trends in sanitation have continued to reduce the burden caused by the foodborne and shorter-lived Hepatitis A and E (Hepatitis D only causes trouble in someone who already has B). The death toll was practically split down the middle between the two viral diseases, and most were the result of chronic infection that led to liver cancer and cirrhosis.

The rise of deaths and disability can mostly be chalked up to a growing population rather than any significant changes in risk factors since 1990. But there’s still plenty to be worried about in the near future. Although viral hepatitis has always been a familiar face of the reaper in countries like America, deaths have become equally common in less developed areas too, which is likely causing the rise in ranking, according to the authors.

And compared to TB, malaria, and HIV, there’s been relatively little global action taken against the disease, possibly explaining why the death toll from the latter group has continued to drop while deaths from the former haven’t.

Poorer countries are already less likely to have access to the vaccine that can prevent Hepatitis B, and though there are newly developed antivirals that can successfully cure Hepatitis C, their exorbitant cost may similarly price these lifesaving medications out of reach for many on either side of the globe without added political and financial will, the authors warned.

“The small proportion of global health funding targeted at viral hepatitis is disproportionate to its importance as a major cause of death and disability,” they concluded. “Our results suggest that an evolution in funding structures is required to accommodate the burden of viral hepatitis and allow effective responses in low-income and lower-middle income countries.”

Source: Stanaway J, Flaxman A, Naghavi M, et al. The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013. The Lancet. 2016.