Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, California.
Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan.
JAMA Netw Open. 2020 Apr 1;3(4):e201844. doi: 10.1001/jamanetworkopen.2020.1844.
To achieve the World Health Organization goal of viral hepatitis elimination by 2030, it is important to estimate current rates of chronic hepatitis B (CHB) diagnosis and treatment.
To provide an accurate accounting of the number of patients with CHB aged 6 years or older who have not yet been diagnosed in the United States.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used the commercial US Truven Health MarketScan Database (138 634 154 privately insured individuals in January 2007 to December 2014) to identify patients with CHB diagnosis and the National Health and Nutrition Examination Survey to estimate the actual number of privately insured persons with CHB. Based on sex and age distribution derived from the US Census Bureau, we calculated the total population with CHB and the proportion of those who remained undiagnosed among the 198 073 302 privately insured individuals. Next, we identified diagnosed CHB patients who received 1 or more prescription for CHB medications to calculate the treatment rate for those with severe disease states, such as cirrhosis and hepatocellular carcinoma, that would warrant treatment. Analyses were performed from October 2017 to January 2020.
The rate and number of patients with CHB who remained undiagnosed and treatment rates for patients with CHB who have cirrhosis or hepatocellular carcinoma.
Among the 198 073 302 privately insured individuals (48.55% male; 15.52% aged 6-17 years; 84.48% aged ≥18 years), there were 511 029 (95% CI, 317 733-704 325) individuals with CHB, but only 95 075 of these had been diagnosed, yielding a diagnosis rate of only 18.60% (95% CI, 13.50%-29.92%), meaning that 81.40% (95% CI, 70.08%-86.50%) were undiagnosed. The treatment rates were 34.79% (95% CI, 33.31%-36.27%) for those with cirrhosis and 48.64% (95% CI, 45.59%-51.69%) for those with hepatocellular carcinoma.
In this study, only approximately 1 in 5 privately insured patients with CHB had been diagnosed. Only one-third of patients with CHB who had cirrhosis and one-half who had hepatocellular carcinoma received antiviral therapy. Further efforts are needed to improve the current situation of poor connection to care for patients with CHB, especially for those with advanced liver disease.
为了实现世界卫生组织 2030 年消除病毒性肝炎的目标，重要的是要估计美国目前慢性乙型肝炎（CHB）的诊断和治疗率。
准确统计出未被诊断的年龄在 6 岁及以上的 CHB 患者人数。
设计、设置和参与者：这项横断面研究使用了商业性美国 Truven Health MarketScan 数据库（2007 年 1 月至 2014 年 12 月期间，138634154 名私人保险个体）来识别 CHB 诊断患者，并使用国家健康和营养检查调查来估计 CHB 的实际私人保险人数。根据美国人口普查局提供的性别和年龄分布，我们计算了 CHB 总人数以及在 198073302 名私人保险个体中未被诊断的比例。接下来，我们确定了诊断为 CHB 的患者中接受了 1 种或多种 CHB 药物处方的患者，以计算那些患有肝硬化和肝细胞癌等严重疾病状态的患者的治疗率，这些疾病需要治疗。分析于 2017 年 10 月至 2020 年 1 月进行。
未被诊断的 CHB 患者比例和人数，以及患有肝硬化或肝细胞癌的 CHB 患者的治疗率。
在 198073302 名私人保险个体中（48.55%为男性；15.52%年龄在 6-17 岁；84.48%年龄≥18 岁），有 511029 人（95%置信区间：317733-704325）患有 CHB，但只有 95075 人被诊断出，诊断率仅为 18.60%（95%置信区间：13.50%-29.92%），意味着 81.40%（95%置信区间：70.08%-86.50%）未被诊断。肝硬化患者的治疗率为 34.79%（95%置信区间：33.31%-36.27%），肝细胞癌患者的治疗率为 48.64%（95%置信区间：45.59%-51.69%）。
在这项研究中，只有约五分之一的患有 CHB 的私人保险患者被诊断出。只有三分之一的肝硬化患者和一半的肝细胞癌患者接受了抗病毒治疗。需要进一步努力改善 CHB 患者目前较差的护理衔接情况，特别是那些患有晚期肝病的患者。
Zotero 插件