Complications of chronic hepatitis B: Prevalence and disparities in a US health system cohort 2006-2016
Lu M, Zhou Y, Li J, Rupp LB, Boscarino JA, Daida YG, Schmidt MA, Trudeau S, and Gordon SC. Complications of chronic hepatitis B: Prevalence and disparities in a US health system cohort 2006-2016. J Hepatol 2019; 70(1):e334-e335.
Background and aims: There are no recent reports of longitudinal trends in chronic hepatitis B (CHB)-related complications among routine clinical care patients in the US. Using data from the Chronic Hepatitis Cohort Study (CHeCS), we analyzed longitudinal rates of cirrhosis, decompensated cirrhosis, and all-cause mortality as well as disparities by age, sex, and race. Method: Join-point and Poisson regression (univariate and multivariate)were used to estimate the annual percent change (APC)in each outcome from 2006 to 2016. Results: A total of 5528 unique CHB patients were included. Prevalence of cirrhosis (including decompensated cirrhosis)doubled from 6.7% in 2006 to 13.7% in 2016. Rates among female patients were roughly half that of male patients (Rate ratio [RR]0.47; p < 0.001). Cirrhosis rates were lowest among the youngest patients and highest among the oldest; rates increased over time in all age groups (adjusted APC (aAPC)3.8-10.8; p < 0.001). Overall prevalence of decompensated cirrhosis increased from 2.3% to 5%; as with cirrhosis, rates were lowest among the youngest patients and highest among the oldest. aAPC increased (aAPC = +6.2%; p < 0.001)but did not differ by sex, age, or race. Incidence of all-cause mortality remained flat across the study period (1.4% to 1.7%), but varied by sex (female vs male RR = 0.61; p < 0.001)and age. APC increased among African Americans (aAPC = +6.2%; p = 0.01)but remained flat among Asian American/Pacific Islander (AAPI)and White patients (p >0.70). [Figure Presented]Conclusion: From 2006 to 2016, prevalence of cirrhosis among CHB patients doubled; rates were highest among older, male, and African American patients. Rates of decompensated cirrhosis also doubled over the study period. Incidence of all-cause mortality was steady in both AAPI and White patients, but increased among African Americans.