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This study investigates risk factors and disease burden associated with chronic hepatitis B virus (HBV) infection in a large prospective cohort study of 0.5 million adults from 10 geographically diverse areas in China, called the China Kadoorie Biobank. Chronic hepatitis B remains a pressing public health issue and is coined a ‘silent epidemic’ in China, which has the largest HBV associated disease burden in the world.