BACKGROUND: As hepatitis A (HA) incidence declines in Europe and HA virus infections occur later in life, severe disease frequency may increase.AIMAmong patients hospitalised for HA in France during 2013-2024, we investigated disease severity and mortality associated-risk factors and temporal trends. METHODS: International Classification of Diseases, 10th Revision codes B150 or B159 as primary discharge diagnosis enabled identifying HA cases from the National Discharge Data Set. Risk factors for severity (hepatic and/or extrahepatic organ failure within 12 weeks post-admission) and mortality were assessed using adjusted odds ratios in original and propensity-matched samples. Trends were determined across five periods covering an HA epidemic in 2017 and the COVID-19 pandemic, with 2013-2016 as reference. RESULTS: Among 7,923 cases (60.6% male, 39.4% female; median age: 30 years), 28.7% (n = 2,277) developed severe HA, and 1.30% (n = 103) died. Severe HA was associated with older age (+ 15% per decade over 30 years, p < 0.001), male sex (+ 38%, p < 0.001), smoking (+ 23%, p = 0.031), risk factors for chronic liver disease (+ 29%, p = 0.041), and cirrhosis (+ 40%, p = 0.054). Mortality was associated with cirrhosis (2.90-fold increase, p = 0.004), Charlson Comorbidity Index (CCI) ≥ 3 (12.3-fold increase, p < 0.001), and modestly with age (+ 24%, p = 0.005), reaching + 90% (p < 0.001) in models without CCI, indicating a considerable comorbidity effect. From 2013-2016, severe HA and HA-related death risks respectively increased 57% (p < 0.001) and 1.96-fold (p = 0.016) in 2021-2024. CONCLUSIONS: Severe HA frequency and mortality increased in French hospitals since 2013. Age and male sex were associated with severe disease, and high CCI with mortality. A more extensive, or even universal, vaccination policy could be considered.