Analysis of electronic health record data of hepatitis B virus (HBV) patients in primary care: hepatocellular carcinoma (HCC) risk associated with socioeconomic deprivation and reduced by statins

Abstract

Background: Chronic hepatitis B infection (CHB) is the leading global cause of hepatocellular carcinoma (HCC), however the CHB population in the UK is not well characterised, and few investigations of risk factors for progression to HCC in multiethnic populations have been undertaken. Methods: We identified CHB individuals from the English primary care database QResearch, containing >35 million patient records. Individuals ≥18 years with a record of CHB between 1999-2019 were included. Risk factors for HCC were investigated using Cox proportional hazards modelling. Results: We identified 8039 individuals with CHB in whom median follow-up was 3.87 years (interquartile range (IQR) 6.30 years). Most individuals (60.4%) were males of non-White ethnicities (>70%), and 44% were in the fifth (most deprived) Townsend deprivation quintile. In multivariable Cox proportional hazards models (undertaken in a subset of 7029 individuals with longitudinal data), 161 HCC cases occurred. Increased hazards of HCC associated with male sex (adjusted hazards ratio (aHR) 3.44, 95% Confidence Interval (95CI) 2.07-5.73), older age (for age groups 56-55 and ≥66 years of age, compared to 26-35 years, aHRs 7.52 (95CI 4.14-13.67) and 11.89 (95CI 6.26-22.60) respectively), socioeconomic deprivation (aHR for fifth Townsend deprivation quintile 1.69, 95CI 1.01-2.84, compared to third), Caribbean ethnicity (aHR 3.32, 95CI 1.43-7.71, compared to White ethnicity), ascites (aHR 1.85, 95CI 1.02-3.36), cirrhosis (aHR 6.52, 95CI 4.54-9.37) and peptic ulcer disease (aHR 2.20, 95CI 1.39-3.49). Reduced HCC hazards associated with statin use (aHR 0.47, 95CI 0.22-0.99). Conclusions: We identified novel risk factors for HCC in an ethnically diverse and socioeconomically deprived population of adults living with CHB.

Cohort Profile: The National Institute for Health Research Health Informatics Collaborative: Hepatitis B Virus (NIHR HIC HBV) research dataset

“…As the prevalence of HBV infection is low across the UK overall, there are limited data describing population characteristics and disease burden. 5 , 6 Chronic HBV (CHB) nevertheless presents a concern in certain populations, either as a result of increased prevalence and/or risk factors for the development of long-term liver disease (e.g. chronic coinfection with HIV 7 or other hepatitis viruses, 8 , 9 diabetes mellitus or metabolic syndrome, 10 , 11 alcohol abuse, 11 migrants from countries/regions with a high prevalence of HBV 12 , 13 ).…”

“…Although comparable HBV datasets are more available in other countries, such as China and the USA, 29–31 there are scarce comprehensive data of HBV in the UK except for data reported from certain populations 32–34 or the primary care population. 5 , 6 We believe this secondary care cohort can start to fill evidence gaps, especially by collating laboratory, imaging and treatment data which are not currently well captured in primary care.…”