WHO Collaborating Centre for Viral Hepatitis, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia.
J Gastroenterol Hepatol. 2023 Jun;38(6):976-983. doi: 10.1111/jgh.16162. Epub 2023 Mar 12.
This study aimed to assess utilization of health-care services in people with decompensated cirrhosis (DC) or hepatocellular carcinoma (HCC) and a "late diagnosis" of hepatitis B or hepatitis C.
Hepatitis B and C cases during 1997-2016 in Victoria, Australia, were linked with hospitalizations, deaths, liver cancer diagnoses, and medical services. A late diagnosis was defined as hepatitis B or hepatitis C notification occurring after, at the same time, or within 2 years preceding an HCC/DC diagnosis. Services provided during the 10-year period before HCC/DC diagnosis were assessed, including general practitioner (GP) or specialist visits, emergency department presentations, hospital admissions, and blood tests.
Of the 25 766 notified cases of hepatitis B, 751 (2.9%) were diagnosed with HCC/DC, and hepatitis B was diagnosed late in 385 (51.3%). Of 44 317 cases of hepatitis C, 2576 (5.8%) were diagnosed with HCC/DC, and hepatitis C was diagnosed late in 857 (33.3%). Although late diagnosis dropped over time, missed opportunities for timely diagnosis were observed. Most people diagnosed late had visited a GP (97.4% for hepatitis B, 98.9% for hepatitis C) or had a blood test (90.9% for hepatitis B, 88.6% for hepatitis C) during the 10 years before HCC/DC diagnosis. The median number of GP visits was 24 and 32, and blood tests 7 and 8, for hepatitis B and C, respectively.
Late diagnosis of viral hepatitis remains a concern, with the majority having frequent health-care service provision in the preceding period, indicating missed opportunities for diagnosis.
本研究旨在评估失代偿期肝硬化（DC）或肝细胞癌（HCC）患者以及乙型肝炎或丙型肝炎“晚期诊断”者的医疗服务利用情况。
将澳大利亚维多利亚州 1997 年至 2016 年期间的乙型肝炎和丙型肝炎病例与住院、死亡、肝癌诊断和医疗服务进行了关联。晚期诊断定义为在 HCC/DC 诊断前 2 年内或同时发生乙型肝炎或丙型肝炎通知。评估了 HCC/DC 诊断前 10 年期间提供的服务，包括全科医生（GP）或专科医生就诊、急诊科就诊、住院和血液检查。
在 25766 例乙型肝炎通知病例中，有 751 例（2.9%）诊断为 HCC/DC，乙型肝炎诊断较晚的有 385 例（51.3%）。在 44317 例丙型肝炎病例中，有 2576 例（5.8%）诊断为 HCC/DC，丙型肝炎诊断较晚的有 857 例（33.3%）。尽管晚期诊断的发生率随着时间的推移而下降，但仍存在错失及时诊断的机会。大多数晚期诊断的患者在 HCC/DC 诊断前 10 年内都曾就诊过全科医生（乙型肝炎为 97.4%，丙型肝炎为 98.9%）或进行过血液检查（乙型肝炎为 90.9%，丙型肝炎为 88.6%）。乙型肝炎和丙型肝炎的平均 GP 就诊次数分别为 24 次和 32 次，血液检查分别为 7 次和 8 次。
乙型肝炎和丙型肝炎的晚期诊断仍然令人担忧，大多数患者在之前的时期内有频繁的医疗服务提供，表明存在错失诊断的机会。
