Epidemiological trends of chronic hepatitis b among routine clinical care patients in the US (2006-2015).

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Background: There are limited data regarding the epidemiological trends of chronic HBV infection among patients under routine care in the US. We used data from four racially‐ and geographically‐diverse health systems participating in the Chronic Hepatitis Cohort Study (CHeCS) to investigate changes in prevalence and incidence of chronic HBV, and the impact of patient demographics on those trends, from 2006–2015. Methods: Electronic medical records at the participating sites were searched to identify all patients with ≥2 ICD codes for hepatitis B ≥6 months apart or laboratory evidence of HBV; chronic HBV was confirmed via chart review or a previously validated Classification and Regression Tree algorithm. Annual percentage changes in chronic HBV prevalence and incidence were estimated using join‐point Poisson regression. Differences in trends based on race, age, and sex were calculated with rate ratios. Analyses were adjusted by geographic region, age, race, and sex. Results: The total CHeCS health system population ranged from 1.9 to 2.4 million persons from 2006 to 2015. Unadjusted prevalence of chronic HBV increased from 150.3 per 100,000 persons in 2006 to 184.2 in 2013, after which it declined to 158.0 in 2015. Join‐point analysis identified two segments; adjusted annual percentage change (aAPC) was 5.6 (95% confidence interval [CI] 4.8, 6.3; p<0.0001) and ‐15.9 (95%CI ‐20.2,‐11.4; p<0.0001) before and after 2014, respectively. Incidence decreased steadily from 16.6 per 100,000 persons in 2006 to 13.4 in 2015; the aAPC was ‐3.2 (95%CI ‐4.6, ‐1.6; p<0.0001). Prior to 2014, prevalence was steady among patients ≤40 years of age but increased in all other age groups; from 2014‐2015, prevalence decreased markedly in all age groups. Incidence rate ratios were 20.5 for Asian American/American Indian/Pacific Islanders (APIs) and 2.8 for African Americans compared to White patients. Prevalence and incidence rates were consistently higher for male versus female patients at a roughly 3:2 ratio. Conclusion: Prevalence of chronic HBV in four large US health care systems increased from 2006 to 2014, after which it decreased sharply. Rates declined most rapidly among patients ≤40 and 61–70 years of age, as well as among APIs. These declines may represent mortality in older APIs and the effects of infant and childhood vaccinations in the younger age categories.



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