Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Healthcare System, Palo Alto.
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford.
J Clin Gastroenterol. 2022 Apr 1;56(4):360-368. doi: 10.1097/MCG.0000000000001530.
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.
及时启动慢性乙型肝炎病毒（CHB）的抗病毒治疗可降低疾病进展的风险。我们评估了符合治疗条件的安全网 CHB 患者的总体治疗率和治疗预测因素。
我们回顾性评估了美国 4 个大型安全网卫生系统 2010 年至 2018 年间的 CHB 成年患者。使用国际疾病分类第 9 版/第 10 版（ICD-9/10）诊断编码和实验室数据来确定 CHB。使用美国肝病研究协会（AASLD）指南来确定治疗的适应证。使用卡方检验、Kaplan-Meier 方法和对数秩检验比较符合治疗条件的患者中 CHB 治疗率。使用调整后的多变量 Cox 比例风险模型评估合格患者接受治疗的独立预测因素。
在 5157 例 CHB 患者中（54.7%为男性，34.6%为非裔美国人，22.3%为亚裔），46.8%在研究期间符合治疗条件。总体 CHB 治疗率为 48.4%，而无人类免疫缺陷病毒（HIV）的 CHB 患者的治疗率为 37.3%。与男性相比，女性（比值比：0.40，95%置信区间：0.33-0.49，P<0.001）和年龄在 65 岁及以上的患者（比值比：0.68，95%置信区间：0.51-0.92，P=0.012）接受治疗的可能性明显较低。相反，与非西班牙裔白人相比，非裔美国人和亚洲人（比值比：1.64，95%置信区间：1.31-2.06，P<0.001）、接受贫困医疗救助的 CHB 患者（比值比：0.36，95%置信区间：0.26-0.50，P<0.001）和非英语患者（比值比：0.53，95%置信区间：0.43-0.65，P<0.001）接受治疗的可能性明显更高。
在大型多中心安全网 CHB 患者队列中，总体有 46.8%的符合治疗条件的 CHB 患者和无 HIV 的符合治疗条件的 CHB 患者（37.3%）接受了抗病毒治疗。鉴于抗病毒治疗在减轻疾病进展方面的明显益处，提高符合治疗条件患者的 CHB 治疗率是“唾手可得的果实”。
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