Mortality Among Patients With Chronic Hepatitis B Infection: The Chronic Hepatitis Cohort Study (CHeCS)

Bixler, Danae; Zhong, Yuna; Ly, Kathleen N.; Moorman, Anne C.; Spradling, Philip R.; Teshale, Eyasu H.; Rupp, Loralee B; Gordon, Stuart C.; Boscarino, Joseph A.; Schmidt, Mark; Daida, Yihe G.; Holmberg, Scott D.

doi:10.1093/cid/ciy598

Cited by 44 publications

(56 citation statements)

References 35 publications

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“…For a diagnosis of HBV or HCV in SEER‐Medicare, we required at least 1 inpatient claim or 2 outpatient or physician claims filed at least 30 days apart during the time frame from 60 months before to 12 months after cancer diagnosis. Previous studies combined acute and chronic hepatitis infection in estimating attributable mortality, 5–9 and we followed that precedent in our primary analyses. For SEER‐Medicare, HBV infection was based on these ICD‐9 codes: 070.20, 070.21, 070.22, 070.23, 070.30, 070.31, 070.32, 070.33, 070.42, 070.52, V02.61.…”

Section: Methodsmentioning

confidence: 99%

“…During the period 2006–2010, only 41% of decedents with a liver‐related death and evidence of chronic hepatitis C in the medical record had HCV listed as a cause of death 8 . Similarly, in this cohort during 2006–2013, only 40% of patients with chronic hepatitis B who died of liver disease had HBV included as a cause on their death certificate 9 …”

Section: Introductionmentioning

confidence: 91%

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Death certificates compared to SEER‐Medicare data for surveillance of liver cancer mortality due to hepatitis B or hepatitis C infection

Jiang

Shiels

O’Brien

2021

Journal of Viral Hepatitis

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Hepatocellular carcinoma (HCC) is often caused by hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. To investigate the completeness of death certificates for recording viral hepatitis in HCC death, we compared the proportion of HCC deaths with hepatitis virus infection reported on death certificates to that reported as claims in the Surveillance, Epidemiology, and End Results (SEER)‐Medicare database among individuals ≥66 years of age. For 2001–2015, we tabulated proportions of HCC deaths with HBV or HCV infection in each database overall, and by demographic factors. To correct for under ascertainment of viral hepatitis‐associated HCC on death certificates, we multiplied by the reciprocal ratio of death certificates to SEER‐Medicare. Among HCC decedents, HBV infection was reported on 3.6% of death certificates and 17.2% of Medicare claims. For HCV, corresponding proportions were 14.9% and 26.9%. The ratio of HBV‐attributable HCC deaths in death certificates to SEER‐Medicare remained ~0.21 over time. The ratio of HCV‐attributable HCC deaths decreased 22.1% per year, from 0.70 in 2001 to 0.37 in 2003, and increased 4.1% per year, from 0.47 in 2004 to 0.66 in 2015. Following correction, the 2015 mortality rate from death certificate data increased from 0.2 to 0.9 per 100,000 for HBV‐attributable HCC and from 2.3 to 3.5 per 100,000 for HCV‐attributable HCC. In conclusion, among older Americans dying from HCC, death certificates captured 21% of HBV and 55% of HCV infections compared to Medicare claims. Our results suggest that death certificates provide incomplete data for viral hepatitis‐associated HCC surveillance.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 91%

Death certificates compared to SEER‐Medicare data for surveillance of liver cancer mortality due to hepatitis B or hepatitis C infection

Jiang

Shiels

O’Brien

2021

Journal of Viral Hepatitis

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“…One possible explanation for the reduction in HBsAg prevalence would be that endemicity started to decrease because of improved infection control practices before immunization [12]. Another possible explanation is that older age groups might have suffered increased mortality from HBV infection [13], and the increased mortality would have reduced the prevalence between 1995 and 2017. With the relatively low prevalence among adults, a focused testing and treatment strategy might be considered in Bhutan (e.g., testing pregnant women, individuals with chronic liver diseases, populations with history of high-risk exposures, and blood donors) [6].…”

Section: Referral To Care Referral To Care Among Hbsag Positive Personsmentioning

confidence: 99%

Prevalence of HBV and HCV infections, Bhutan, 2017: Progress and next steps

Tshering¹,

Dhakal

Wangchuk

et al. 2020

BMC Infect Dis

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Background: Bhutan is committed to eliminating hepatitis B and hepatitis C, though recent baseline estimates of disease burden in the general population are unknown. In 2017, we carried out a biomarker survey in the general population to estimate the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) biomarkers to evaluate the impact of immunization and guide further efforts. Methods: In 2017, a cross-sectional, population-based, three-stage cluster survey was undertaken of the general population (1-17 and 20+ years of age). We visited households, collected blood specimens and administered a standard questionnaire. Specimens were collected for hepatitis B surface antigen (HBsAg) and hepatitis C virus antibody (anti-HCV) testing. We calculated prevalence of infection and selected characteristics, along with confidence intervals (CIs). Results: Of 1372 individuals approached, 1358 (99%) participated. Of those, 1321 (97%) had a specimen tested for HBsAg, and among 1173 enrolled individuals 5 years of age or older, 1150 (98%) individuals were tested for anti-HCV. The prevalence of HBsAg was 2.0% in 775 persons 20 years of age or older (95% CI: 1.0-4.0) and 0.5% in 546 persons 1-17 years of age (95% CI: 0.1-1.8). The prevalence of anti-HCV was 0.3% (95% CI: 0.1-0.8) among persons ≥5 years. Conclusions: Universal hepatitis B immunization of infants has resulted in a low prevalence of chronic HBV infection in persons 1-17 years of age and the prevalence of anti-HCV is low among persons aged ≥5 years. Efforts should continue to reach high coverage of the timely birth dose along with completion of the hepatitis B vaccine series. To reduce the chronic liver disease burden among adults, HBV and HCV testing and treatment as indicated might be restricted to pregnant women, blood donors, individuals with chronic liver diseases, and other groups with history of high-risk exposures.

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“…The CHB patients were subjected to death at an average age of 59.8 years, which is 14 years earlier than the general population. 10 Another study showed that death rates due to liver abnormality in CHB subjects are significantly higher after 40 years of age. 11 The HBV vaccination program has been introduced since 1980 and has proved to be effective to boost long-lasting immunity against HBV and thus was considered as highly successful in reducing HBV-associated disease burden.…”

Section: Introductionmentioning

confidence: 99%

A Dynamic Mathematical Modeling Revelation about the Impact of Vaccination on Hepatitis B Virus-induced Infection and Death Rate in Bangladesh

Chakraborty

Chakravorty

Alam

et al. 2017

Euroasian Journal of Hepato-Gastroenterology

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Aim: Attainment of sustainable development goal (SDG) targets requires reducing the rate of new hepatitis B virus (HBV)-induced infection and mortality rate to 90% and 65%, respectively, by 2030. Therefore, it is important to investigate the feasibility of reducing the required rates of HBV-induced infection and death incidents at the current rate of vaccination coverage in Bangladesh. Moreover, factors influencing vaccination coverage like negative bias toward girls during immunization can affect the current vaccination program and ultimately hinder the efforts to reduce HBV-induced infection and death rates. To investigate the possibility of reducing HBV-induced infection and death rates with current vaccination coverage, we adopted mathematical molding-based approach. Materials and methods: We developed a mathematical model based on the susceptible-infectious-recovered model to simulate the HBV-induced infection in children under the age of five at three different vaccination rates: 80, 90, and 95%. Additionally the impact of current vaccination coverage was assessed on HBV-induced death rates in the future. Moreover, we took advantage of the mathematical model to investigate the impact of negative bias toward girls in vaccination program on HBV-induced infection and death rates. Results: The model simulations revealed that 10% increase in the vaccination rate from 80 to 90% can potentially contribute to the significant lowering (around 40%) of HBV-induced infection rate among children. When increased by 5% of vaccination rate from 90 to 95%, the HBV-infection rate is likely to be decreased by another 22%. Likewise, 44% reduction in HBV-induced death rate in the future (2050 onward) can potentially be achieved by 10% increase in the current vaccination rate from 80 to 90%, whereas 5% increase in the current vaccination rate (90-95%) may lead to 24% further reduction of death rate. These results underscored the significant impact of vaccination in reducing HBV-induced infection among children and future death rates in adults. Moreover, at 90% vaccination coverage, the negative bias of vaccination toward girls contributes to an increase of 15 and 12% of HBV-induced infection and death rates, respectively, in female subjects compared to their male counterparts. Conclusion: The current vaccination coverage (80-90%) is further aggravated by untimely vaccination, dropouts from vaccination program, and negative bias toward girls in vaccination program. Therefore, if the current situation persists, it will not be possible to accomplish the required reduction in HBV-induced infection and death rates by 2030, according to the SDG guidelines. Moreover negative bias in the vaccination program may intensify the HBV-induced infection and death rates in the future. Clinical significance: In light of the mathematical model, we suggest that the vaccination coverage should be increased to 95% without any negative bias toward girls. To accomplish this, the concerning authorities must ensure timely and full completion of the HBV ...

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Mortality Among Patients With Chronic Hepatitis B Infection: The Chronic Hepatitis Cohort Study (CHeCS)

Abstract: Compared to the general population, CHB patients die at a younger age and at higher rates from all causes and liver-related causes. Death certificates underrepresent the true mortality from CHB.

Cited by 44 publications

References 35 publications

Death certificates compared to SEER‐Medicare data for surveillance of liver cancer mortality due to hepatitis B or hepatitis C infection

Death certificates compared to SEER‐Medicare data for surveillance of liver cancer mortality due to hepatitis B or hepatitis C infection

Prevalence of HBV and HCV infections, Bhutan, 2017: Progress and next steps

A Dynamic Mathematical Modeling Revelation about the Impact of Vaccination on Hepatitis B Virus-induced Infection and Death Rate in Bangladesh

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