Low Rates of Hepatitis B Virus Treatment Among Treatment-Eligible Patients in Safety-Net Health Systems.
Journal
Journal of clinical gastroenterology
ISSN: 1539-2031
Titre abrégé: J Clin Gastroenterol
Pays: United States
ID NLM: 7910017
Informations de publication
Date de publication:
01 04 2022
01 04 2022
Historique:
received:
22
11
2020
accepted:
10
02
2021
pubmed:
30
3
2021
medline:
12
4
2022
entrez:
29
3
2021
Statut:
ppublish
Résumé
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. 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 χ2 testing, Kaplan Meier methods and log-rank testing. Adjusted multivariate Cox proportional hazards models evaluated independent predictors of receiving treatment among eligible patients. 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. 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.
Sections du résumé
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 χ2 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.
Identifiants
pubmed: 33780210
pii: 00004836-202204000-00012
doi: 10.1097/MCG.0000000000001530
doi:
Substances chimiques
Antiviral Agents
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
360-368Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Références
Polaris Observatory C. Global prevalence, treatment, and prevention of hepatitis B virus infection in 2016: a modelling study. Lancet Gastroenterol Hepatol. 2018;3:383–403.
Terrault NA, Lok ASF, McMahon BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018;67:1560–1599.
Kowdley KV, Wang CC, Welch S, et al. Prevalence of chronic hepatitis B among foreign-born persons living in the United States by country of origin. Hepatology. 2012;56:422–433.
Wasley A, Kruszon-Moran D, Kuhnert W, et al. The prevalence of hepatitis B virus infection in the United States in the era of vaccination. J Infect Dis. 2010;202:192–201.
Ioannou GN. Hepatitis B virus in the United States: infection, exposure, and immunity rates in a nationally representative survey. Ann Intern Med. 2011;154:319–328.
Gish RG, Cohen CA, Block JM, et al. Data supporting updating estimates of the prevalence of chronic hepatitis B and C in the United States. Hepatology. 2015;62:1339–1341.
Kim HS, Rotundo L, Yang JD, et al. Racial/ethnic disparities in the prevalence and awareness of Hepatitis B virus infection and immunity in the United States. J Viral Hepat. 2017;24:1052–1066.
Harris AM, Link-Gelles R, Kim K, et al. Community-based services to improve testing and linkage to care among non-US-born persons with chronic hepatitis B virus infection—three US Programs, October 2014-September 2017. MMWR Morb Mortal Wkly Rep. 2018;67:541–546.
Nguyen VG, Wan K, Trinh HN, et al. Chronic hepatitis B treatment eligibility and actual treatment rates in patients in community gastroenterology and primary care settings. J Clin Gastroenterol. 2015;49:145–149.
Zhang S, Ristau JT, Trinh HN, et al. Undertreatment of Asian chronic hepatitis B patients on the basis of standard guidelines: a community-based study. Dig Dis Sci. 2012;57:1373–1383.
Tang E, Liu B, Bhuket T, et al. Low rates of linkage and retention into care among patients with chronic HBV infection. Clin Gastroenterol Hepatol. 2019;17:1909–1911.
Harris AM, Millman AJ, Lora M, et al. Hepatitis B testing, care linkage, and vaccination coverage within a registry of hepatitis C infected patients. Vaccine. 2019;37:2188–2193.
Papatheodoridis GV, Lampertico P, Manolakopoulos S, et al. Incidence of hepatocellular carcinoma in chronic hepatitis B patients receiving nucleos(t)ide therapy: a systematic review. J Hepatol. 2010;53:348–356.
Liaw YF, Sung JJ, Chow WC, et al. Lamivudine for patients with chronic hepatitis B and advanced liver disease. N Engl J Med. 2004;351:1521–1531.
Marcellin P, Gane E, Buti M, et al. Regression of cirrhosis during treatment with tenofovir disoproxil fumarate for chronic hepatitis B: a 5-year open-label follow-up study. Lancet. 2013;381:468–475.
Jain MK, Thamer M, Therapondos G, et al. Has access to hepatitis C virus therapy changed for patients with mental health or substance use disorders in the direct-acting-antiviral period? Hepatology. 2019;69:51–63.
Gordon SC, Lamerato LE, Rupp LB, et al. Antiviral therapy for chronic hepatitis B virus infection and development of hepatocellular carcinoma in a US population. Clin Gastroenterol Hepatol. 2014;12:885–893.
Kim WR, Loomba R, Berg T, et al. Impact of long-term tenofovir disoproxil fumarate on incidence of hepatocellular carcinoma in patients with chronic hepatitis B. Cancer. 2015;121:3631–3638.
Lok AS, McMahon BJ, Brown RS Jr, et al. Antiviral therapy for chronic hepatitis B viral infection in adults: a systematic review and meta-analysis. Hepatology. 2016;63:284–306.
Iloeje UH, Yang HI, Su J, et al. Predicting cirrhosis risk based on the level of circulating hepatitis B viral load. Gastroenterology. 2006;130:678–686.
Chen CF, Lee WC, Yang HI, et al. Changes in serum levels of HBV DNA and alanine aminotransferase determine risk for hepatocellular carcinoma. Gastroenterology. 2011;141:1240–1248; 1248 e1241-1242.
Le MH, Yeo YH, Cheung R, et al. Chronic hepatitis B prevalence among foreign-born and US-born adults in the United States, 1999-2016. Hepatology. 2020;71:431–443.
Saluja S, McCormick D, Cousineau MR, et al. Barriers to primary care after the affordable care act: a qualitative study of los angeles safety-net patients’ experiences. Health Equity. 2019;3:423–430.
Figueroa JF, Joynt KE, Zhou X, et al. Safety-net hospitals face more barriers yet use fewer strategies to reduce readmissions. Med Care. 2017;55:229–235.
Wong RJ, Khalili M. A patient-centered hepatitis B virus (HBV) educational intervention improves HBV care among underserved safety-net populations. J Clin Gastroenterol. 2020;54:642–647.
Chu D, Yang JD, Lok AS, et al. Hepatitis B screening and vaccination practices in asian american primary care. Gut Liver. 2013;7:450–457.
Harris AM, Schoenbachler BT, Ramirez G, et al. Testing and linking foreign-born people with chronic hepatitis B virus infection to care at nine US Programs, 2012-2014. Public Health Rep. 2016;131(suppl 2):20–28.
Mukhtar NA, Kathpalia P, Hilton JF, et al. Provider, patient, and practice factors shape hepatitis B prevention and management by primary care providers. J Clin Gastroenterol. 2017;51:626–631.
Shah HA, Abu-Amara M. Education provides significant benefits to patients with hepatitis B virus or hepatitis C virus infection: a systematic review. Clin Gastroenterol Hepatol. 2013;11:922–933.
Mukhtar NA, Toy BC, Burman BE, et al. Assessment of HBV preventive services in a medically underserved Asian and Pacific Islander population using provider and patient data. J Gen Intern Med. 2015;30:68–74.
Hu DJ, Xing J, Tohme RA, et al. Hepatitis B testing and access to care among racial and ethnic minorities in selected communities across the United States, 2009-2010. Hepatology. 2013;58:856–862.
Fitzgerald S, Chao J, Feferman Y, et al. Hepatitis B and hepatocellular carcinoma screening practices in Chinese and African immigrant-rich neighborhoods in New York City. J Racial Ethn Health Disparities. 2016:10.1007/s40615-016-0296-y.
doi: 10.1007/s40615-016-0296-y
Shiau R, Bove F, Henne J, et al. Using survey results regarding hepatitis B knowledge, community awareness and testing behavior among Asians to improve the San Francisco Hep B Free campaign. J Community Health. 2012;37:350–364.
Hyun CS, Ko O, Lee S, et al. Long term outcome of a community-based hepatitis B awareness campaign: eight-year follow-up on linkage to care (LTC) in HBV infected individuals. BMC Infect Dis. 2019;19:638.
Zhou K, Fitzpatrick T, Walsh N, et al. Interventions to optimise the care continuum for chronic viral hepatitis: a systematic review and meta-analyses. Lancet Infect Dis. 2016;16:1409–1422.
Mokdad AA, Murphy CC, Pruitt SL, et al. Effect of hospital safety net designation on treatment use and survival in hepatocellular carcinoma. Cancer. 2018;124:743–751.
Mobley L, Kuo TM, Bazzoli GJ. Erosion in the healthcare safety net: impacts on different population groups. Open Health Serv Policy J. 2011;4:1–14.
Cunningham P, Felland L, Stark L. Safety-net providers in some US communities have increasingly embraced coordinated care models. Health Aff (Millwood). 2012;31:1698–1707.