New data highlight US hepatitis burden
Moorman A. Clin Infect Dis. 2013;56:40-50.
Recent data highlight the chronic viral hepatitis burden in the United States, especially among baby boomers. Patients aged 44 to 63 years comprised 50% of all hepatitis B virus infections and 75% of all hepatitis C virus infections.
The Chronic Hepatitis Cohort Study was a prospective longitudinal, observational cohort study in which researchers reviewed the medical records of more than 1.6 million adults who were seen from 2006 to 2010. Among those, 2,202 had confirmed chronic HBV and 8,810 had confirmed chronic HCV.
In the cohort of patients with HBV infection, 57.8% were Asian/Pacific Islander, 28.3% were white and 13.3% were black. Most of the patients (76.3%) had private insurance, 16.5% had Medicare and 5.1% had Medicaid. From 2001 to 2010, 22.3% of patients had a liver biopsy, 37.9% were hospitalized at least once and 2.1% underwent liver transplant for end-stage liver disease. The death rate was 21.6 per 1,000 person-years
Among patients with HCV infection, 69.5% were white, 22.7% were black and 5.9% were Asian/Pacific Islander. Most of the patients (61.8%) had private insurance, 12.1% had Medicaid and 22.9% had Medicare. From 2001 to 2010, 38.4% of patients had a liver biopsy and 44.3% had been hospitalized at least once. In addition, 4.7% of patients underwent liver transplant for end-stage liver disease. The death rate was 33 per 1,000 person-years. In this cohort, 28% of patients had also been tested for HIV, of whom 2.9% were positive.
“[The Chronic Hepatitis Cohort Study] has already generated unique information about the high morbidity and mortality in this population,” the researchers wrote. “It is expected to yield much data-driven information about the impact of therapies, comorbidities and conditions on the general population with HBV and HCV in the future.”
The CDC recently recommended that all baby boomers, those born between 1945 and 1965, receive a one-time test for HCV.
Disclosure: The researchers report no relevant financial disclosures.
The Chronic Hepatitis Cohort Study was a prospective longitudinal, observational cohort study in which researchers reviewed the medical records of more than 1.6 million adults who were seen from 2006 to 2010. Among those, 2,202 had confirmed chronic HBV and 8,810 had confirmed chronic HCV.
In the cohort of patients with HBV infection, 57.8% were Asian/Pacific Islander, 28.3% were white and 13.3% were black. Most of the patients (76.3%) had private insurance, 16.5% had Medicare and 5.1% had Medicaid. From 2001 to 2010, 22.3% of patients had a liver biopsy, 37.9% were hospitalized at least once and 2.1% underwent liver transplant for end-stage liver disease. The death rate was 21.6 per 1,000 person-years
Among patients with HCV infection, 69.5% were white, 22.7% were black and 5.9% were Asian/Pacific Islander. Most of the patients (61.8%) had private insurance, 12.1% had Medicaid and 22.9% had Medicare. From 2001 to 2010, 38.4% of patients had a liver biopsy and 44.3% had been hospitalized at least once. In addition, 4.7% of patients underwent liver transplant for end-stage liver disease. The death rate was 33 per 1,000 person-years. In this cohort, 28% of patients had also been tested for HIV, of whom 2.9% were positive.
“[The Chronic Hepatitis Cohort Study] has already generated unique information about the high morbidity and mortality in this population,” the researchers wrote. “It is expected to yield much data-driven information about the impact of therapies, comorbidities and conditions on the general population with HBV and HCV in the future.”
The CDC recently recommended that all baby boomers, those born between 1945 and 1965, receive a one-time test for HCV.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
Anna Lok
- This study aims to determine the health burden from hepatitis B and hepatitis C in the United States. The unique aspect of this study is that it provides a glimpse of the percentage of patients receiving care who have hepatitis B or C and the morbidity and mortality. The study combines retrospective chart review and prospective follow-up and has the potential of yielding more reliable data of real world practice than studies using administrative databases that rely on diagnosis or billing codes. The authors found that 50% of those with chronic hepatitis B and 75% of those with chronic hepatitis C were between the age of 44 and 63 years. During the study, 9% of patients with chronic hepatitis B and 14% of those with chronic hepatitis C died, and 2.1% of patients with chronic hepatitis B and 4.7% of those with chronic hepatitis C had undergone liver transplantation. Most of the deaths and liver transplantations occurred in those aged 44-63 years. These data highlight the substantial health burden of chronic hepatitis B and chronic hepatitis C in the US and provide support for CDC’s recent recommendation to screen Americans born between 1945-1965 for hepatitis C, so that those infected can be diagnosed early and have the potential to benefit from antiviral treatment. This is particularly important because hepatitis C treatment is rapidly evolving and new treatment regimens are more effective, have less side effects and of shorter duration.
- Anna Lok, MD
- Professor of hepatology, University of Michigan
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