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Background: Understanding factors associated with liver disease progression among patients with chronic hepatitis B (CHB) is vital for clinical decision-making. We examined liver related outcomes and mortality among CHB patients using clinical and laboratory data, supplemented by an in-depth health and behavior survey conducted in 2011-2012.

Methods: CHB patients at four large U.S. healthcare systems completed a cross-sectional survey of demographic characteristics, smoking history, drug/alcohol use, coffee intake, and physical and psychosocial functioning. We reviewed survey responses and electronic medical records (EMRs) to examine clinical outcomes, including death, and determined patient characteristics at the time of survey associated with progression to decompensated cirrhosis [DCC] or hepatocellular carcinoma [HCC]) through the end of 2016, using a Cox model adjusted for age, sex, CHB diagnosis date, cirrhosis status, treatment history, diabetes mellitus, and alanine aminotransferase level.

Results: Among 996 eligible CHB respondents, median age was 49 years, 51% were male, 34% were US-born, 55% were Asian-born, 69% were employed, 72% had a college or graduate education, 70% had private insurance, 38% were ever smokers (11% were current), 10% consumed alcohol >2 times per week, and 2% reported a history of injection drug use. At the time of survey, 34% were currently receiving or had taken antiviral treatment in the past, 75% had FIB4 values ≤2.0, and 15 (1.5%) had received a liver transplant. Median EMR follow-up after survey among respondents was 4.6 years. As of December 31, 2016, 50 (5%) patients had died (including 11 [22%] liver-related deaths). After exclusion of 43 patients with a history of DCC, HCC, or liver transplant at the time of survey, 29 of 953 (3%) patients developed DCC (n=19) or HCC (n=7) or both (n=3) during follow-up; median time to DCC or HCC was 2.3 years. Characteristics at time of survey associated with development of DCC or HCC included age ≥65 years (adjusted Hazard Ratio [aHR] 3.3, vs. ageyears), FIB4 >3.0 (aHR 16.2, vs. FIB420 years), and antiviral treatment initiation(aHR 2.3, vs. >10 years). Country of birth, insurance status, smoking, alcohol and drug use, and coffee intake were not associated with development of DCC or HCC after the survey.

Conclusion: After approximately five years of follow-up post-survey, liver-related deaths and incident HCC and DCC were uncommon. The association of incident DCC and HCC with recent CHB diagnosis and treatment initiation highlights the importance of earlier diagnosis of CHB and appropriate surveillance and care to prevent severe health outcomes.



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