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Abstract Details
Low Rates of Hepatitis B Virus Treatment Among Treatment-Eligible Patients in Safety-Net Health Systems
J Clin Gastroenterol. 2021 Mar 17. doi: 10.1097/MCG.0000000000001530. Online ahead of print.
Robert J Wong1, Mamta K Jain, George Therapondos, Bolin Niu, Onkar Kshirsagar, Mae Thamer
Author information
1*Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Healthcare System, Palo Alto †Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford ‡Division of Gastroenterology and Hepatology, Alameda Health System-Highland Hospital, Oakland, CA §Division of Infectious Diseases, University of Texas Southwestern Medical Center ?Parkland Health and Hospital System, Dallas, TX ¶Multi-Organ Transplant Institute, Ochsner Health System, New Orleans, LA #Division of Gastroenterology and Hepatology, MetroHealth System, Cleveland, OH **Medical Technology and Practice Patterns Institute, Bethesda, MD.
Abstract
Background: Timely initiation of antiviral therapy in chronic hepatitis B virus (CHB) reduces risk of disease progression. We evaluate overall treatment rates and predictors of treatment among treatment-eligible safety-net CHB patients.
Methods: We retrospectively evaluated adults with CHB from 2010 to 2018 across 4 large safety-net health systems in the United States. CHB was identified with ICD-9/10 diagnosis coding and confirmed with laboratory data. Treatment eligibility was determined using American Association for the Study of Liver Diseases (AASLD) guidelines. Comparison of CHB treatment rates among treatment-eligible patients were performed using χ testing, Kaplan Meier methods and log-rank testing. Adjusted multivariate Cox proportional hazards models evaluated independent predictors of receiving treatment among eligible patients.
Results: Among 5157 CHB patients (54.7% male, 34.6% African American, 22.3% Asian), 46.8% were treatment-eligible during the study period. CHB treatment rates were 48.4% overall and 37.3% among CHB patients without human immunodeficiency virus. Significantly lower odds of treatment were observed in females versus males (odds ratio: 0.40, 95% confidence interval: 0.33-0.49, P<0.001) and patients age 65 years or above versus age below 45 years (odds ratio: 0.68, 95% confidence interval: 0.51-0.92, P=0.012). Conversely, significantly greater odds of treatment were observed in African American and Asians versus non-Hispanic whites, CHB patients with indigent care versus commercially insured patients, and non-English speaking versus English speaking patients.
Conclusion: Among a large multicentered, safety-net cohort of CHB patients, 46.8% of treatment-eligible CHB patients overall and 37.3% of treatment-eligible CHB patients without human immunodeficiency virus received antiviral therapy. Improving CHB treatment rates among treatment-eligible patients represents "low hanging fruit," given the clear benefits of antiviral therapy in mitigating disease progression.