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Abstract Details
Diagnosis of Chronic Hepatitis B Pericomplication: Risk factors and Trends Over Time
Hepatology. 2021 Jun;73(6):2141-2154. doi: 10.1002/hep.31557. Epub 2021 Jun 15.
Lauren Lapointe-Shaw12345, Hannah Chung3, Laura Holder3, Jeffrey C Kwong34678, Beate Sander2346910, Peter C Austin310, Harry L A Janssen12411, Jordan J Feld12411
Author information
1Department of Medicine, University of Toronto, Toronto, ON, Canada.
2Toronto General Hospital Research Institute, Toronto, ON, Canada.
3ICES, Toronto, ON, Canada.
4Department of Medicine, University Health Network, Toronto, ON, Canada.
5Women's Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.
6Public Health Ontario, Toronto, ON, Canada.
7Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
8Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
9Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada.
10Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
11Toronto Centre for Liver Disease, Toronto, ON, Canada.
Abstract
Background and aims: Hepatitis B virus (HBV) is a major cause of chronic liver disease, which can progress to cirrhosis, hepatocellular carcinoma, and death. A timely diagnosis allows for antiviral treatment, which can prevent liver-related complications. Conversely, a late diagnosis signals a missed opportunity for earlier care and treatment. Our objective was to measure the proportion of chronic HBV diagnoses that are made within 6 months of presentation with a liver disease-related complication and examine associated factors and trends over time.
Approach and results: We used provincial laboratory data to identify patients with chronic HBV diagnosed from 2003 to 2014. We measured the proportion who experienced a liver disease complication (decompensated cirrhosis, hepatocellular carcinoma, or liver transplant) within ±6 months of their HBV diagnosis date. A multivariable logistic regression model was used to identify factors associated with HBV diagnosis pericomplication. Of 18,434 patients with chronic HBV, 1,279 (6.9%) developed an HBV-related complication during the follow-up period. Among these, 570 (44.6%) had a first diagnosis pericomplication. HBV diagnosis pericomplication did not decrease over time and was independently associated with older age at HBV diagnosis, rural residence, alcohol use, and moderate to high levels of comorbidity. Female patients, immigrants, and those with more outpatient physician visits were less likely to have an HBV diagnosis pericomplication.
Conclusions: A high proportion of patients with HBV-related complications are first diagnosed with HBV pericomplication. These signal missed opportunities for earlier detection and treatment. Our findings support expansion of HBV screening.