Wong Robert J, Jain Mamta K, Niu Bolin, Therapondos George, Kshirsagar Onkar, Thamer Mae
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California, USA.
Gastroenterology Section, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA.
Open Forum Infect Dis. 2024 Oct 1;11(10):ofae571. doi: 10.1093/ofid/ofae571. eCollection 2024 Oct.
Timely treatment of chronic hepatitis B (CHB) reduces risks of cirrhosis and hepatocellular carcinoma. Gaps in timely treatment persist, especially among underserved safety-net populations. We aim to evaluate gaps and disparities in CHB treatment in the United States.
Adults with treatment-naive CHB without human immunodeficiency virus were identified from 2010 to 2018 across 3 safety-net health systems. CHB treatment eligibility was assessed using American Association for the Study of Liver Diseases (AASLD) criteria and alternative criteria, including the Simplified Approach for Hepatitis B Algorithm. Differences in CHB treatment between groups were evaluated using χ methods, adjusted Kaplan-Meier methods, and adjusted Cox proportional hazards models.
Among 3749 patients with treatment-naive CHB (51.5% women, 38.7% White, 33.7% African American, 19.6% Asian, 24.6% cirrhosis), 30.0% were AASLD treatment eligible, among whom 31.0% were treated. Men were more likely than women to be treated (33.5% vs 26.6%, < .01). On multivariable regression, there remained a trend toward greater treatment in men versus women (adjusted hazard ratio [aHR], 1.21 [95% confidence interval {CI}, .96-1.54]). Disparities by race/ethnicity and insurance status were observed. When exploring outcomes using SABA criteria, similar trends were observed. Among treatment-eligible patients, greater likelihood of treatment was observed in men versus women (aHR, 1.40 [95% CI, 1.14-1.70]) and in Asians versus Whites (aHR, 1.50 [95% CI, 1.16-1.94]).
Among an ethnically diverse multicenter safety-net cohort of CHB patients, less than one-third of treatment-eligible patients received antiviral treatment. Significant disparities in CHB treatment were observed by sociodemographic characteristics.
及时治疗慢性乙型肝炎（CHB）可降低肝硬化和肝细胞癌的风险。及时治疗方面仍存在差距，尤其是在服务不足的安全网人群中。我们旨在评估美国CHB治疗中的差距和差异。
2010年至2018年期间，在3个安全网卫生系统中识别出未接受过治疗的成年CHB患者，且这些患者未感染人类免疫缺陷病毒。使用美国肝病研究协会（AASLD）标准和替代标准（包括乙型肝炎简化治疗方案）评估CHB治疗的 eligibility。使用χ方法、调整后的Kaplan-Meier方法和调整后的Cox比例风险模型评估各组之间CHB治疗的差异。
在3749例未接受过治疗的CHB患者中（51.5%为女性，38.7%为白人，33.7%为非裔美国人，19.6%为亚洲人，24.6%有肝硬化），30.0%符合AASLD治疗标准，其中31.0%接受了治疗。男性接受治疗的可能性高于女性（33.5%对26.6%，P<0.01）。在多变量回归分析中，男性与女性相比仍有接受更多治疗的趋势（调整后风险比[aHR]，1.21[95%置信区间{CI}，0.96-1.54]）。观察到种族/族裔和保险状况方面的差异。在使用SABA标准探索结果时，观察到类似趋势。在符合治疗标准的患者中，男性接受治疗的可能性高于女性（aHR，1.40[95%CI，1.14-1.70]），亚洲人高于白人（aHR，1.50[95%CI，1.16-1.94]）。
在一个种族多样化的多中心安全网CHB患者队列中，不到三分之一符合治疗标准的患者接受了抗病毒治疗。观察到CHB治疗在社会人口学特征方面存在显著差异。
