By Ethan Covey
Data from a nationwide managed care database shed new light on the factors that contribute to delayed diagnosis of chronic hepatitis B virus (HBV).

The findings, presented in a poster study at Digestive Disease Week 2024, underscore the challenges of managing HBV in the United States. The infection affects an estimated 880,000 to 1.89 million people, according to data from the U.S. Department of Health and Human Services. 

These chronic HBV cases cause significant disease burden and complicate efforts to meet WHO 2030 viral hepatitis elimination goals, noted Mindie H. Nguyen, MD, a professor of medicine at Stanford Medicine in Redwood City, Calif., and a co-author of the study (poster Sa1661).

Despite those high stakes, HBV disease awareness is low: Only 15% of those with chronic infection are aware of their condition (Hepatology 2020;71[2]:431-443), Dr. Nguyen stressed. 

To estimate the true prevalence of chronic HBV in the United States, and factors associated with late diagnosis, Dr. Nhuyen and her colleagues conducted a retrospective analysis of patients in the Truven MarketScan database from January 2007 to December 2021. Late diagnosis of chronic HBV was defined as a diagnosis after or within two years of first liver complication.

A total of 2,497 patients met the inclusion criteria and were included in the analysis. Of these, the mean age was 54.9 years, and 77% of the patients met the criteria for late diagnosis.

Late diagnosis was more common in males (71.8% vs. 66.8%; P=0.023), alcohol users (15.8% vs. 5.5%; P<0.001), those with insurance from a preferred provider organization (54.9% vs. 45.7%; P<0.001) and a higher median Charlson Comorbidity Index (5 vs. 4; P<0.001). 

In addition, late diagnosis was more common during 2013-2021 than during 2007-2013 (43.7% vs. 24.2%; P<0.001). The researchers also found that an earlier diagnosis was more common among those taking antiviral medications (57.8% vs. 31.8%; P<0.001). Significant predictors for late disease complications were found to include alcohol (odds ratio [OR], 2.11; 95% CI, 1.42-3.25; P<0.001) and a diagnosis made after 2013 (OR, 2.33; 95% CI, 1.83-2.98; P<0.001).

“This is a nationwide study of patients with private insurance that found the majority of hepatitis B patients with severe complications such as cirrhosis and liver cancer had their hepatitis B diagnosis only within the 12 months or so leading to the complications,” Dr. Nguyen said. “This suggests severe underdiagnosis of hepatitis B even among insured patients in the U.S., a high-income country.”

Dr. Nguyen added that the data “are consistent with prior studies suggesting that only about 18% of hepatitis B patients in the U.S. have been diagnosed, and the WHO estimates that only about 10% of the global hepatitis B population have been diagnosed.”

Addressing these issues to meet WHO goals will take a concerted effort, according to Dr. Nguyen. “We should increase provider and patient awareness through education, patient outreach programs and system commitment, such as adding HBsAg [HBV surface antigen testing] (as is done for HCV) to routine health checkup panels in primary care.”

Those steps are needed “because universal HBV—as well as HCV—screening is now recommended for all adults in the U.S.,” she said.

Dr. Nguyen added that she hopes future research will answer lingering questions, such as what types of interventions would be effective for reaching at-risk populations and closing the gaps in diagnosis highlighted in her study. Such efforts, she added, hopefully will “encourage provider compliance and adherence to practice guidelines.”

Dr. Nguyen reported no relevant financial disclosures.