Chronic hepatitis B virus infection and the risk of hepatocellular carcinoma by age and country of origin in people living in Sweden: A national register study

Abstract

Chronic hepatitis B virus (HBV) infection is a major risk factor for hepatocellular carcinoma (HCC), and surveillance is recommended for patients without cirrhosis when risk exceeds an incidence rate (IR) of 0.2%. Populations in Asia and sub‐Saharan Africa have been associated with HCC at younger ages, but the risk after immigration to Western countries should be investigated. The aim of this study was to study HCC by age and country of origin in people with chronic HBV infection in Sweden. Through national registers, residents with chronic HBV diagnosis (1990–2015) were identified with information on country of origin, immigration/emigration, death, coinfections, antiviral therapy, and HCC. Observation time started at HBV diagnosis, and IR and hazard ratios for HCC were calculated by sex, age, and region of origin. Among 16,410 individuals (47% women), the origin and observation time (person years) were as follows: Western Europe, 2316 (25,415); Eastern Europe, 2349 (26,237); Middle East/North Africa, 4402 (47,320); sub‐Saharan Africa, 3677 (30,565); Asia, 3537 (35,358); and other, 129 (1277). There were 232 individuals with HCC (82% in men). The IR increased with age and exceeded 0.2% for Asian men from age group 40–49 years (IR, 0.63; 95% confidence interval, 0.39–1.00), for men of other origins from age group 50–59 years, and for women aged ≥60 years originating from Eastern Europe, Asia, and Middle East/North Africa. After exclusion of patients with cirrhosis or HBV treatment, the IR still exceeded 0.2% in Asian men aged 40–49 years. This study demonstrates that HBV‐infected men of Asian origin should be recommended HCC surveillance at younger ages, but there is a need for further studies of HCC incidence in African‐born men without cirrhosis living in the Western world.

Racial Disparities in Treatment Initiation and Outcomes of Chronic Hepatitis B Virus Infection in North America

“…Asian individuals with CHB also have a higher incidence of HCC and earlier occurrence. 33 In this study, Asian participants had the highest prevalence of HBeAg and the highest percentage meeting treatment criteria and were most likely to initiate treatment; however, treatment initiation among those eligible was comparable to that of African American or Black and White participants, and clinical outcomes including HCC were also similar.…”

Global, regional, and national burdens of hepatitis B-associated cirrhosis in children and adolescents from 1990 to 2019 and joinpoint regression

“…Although the World Health Organization recommended universal vaccination with the hepatitis B vaccine for children in 1995, Denmark, Finland, Iceland, Ireland, the Netherlands, Norway, Sweden, and the UK adopted a selective vaccination strategy for high-risk groups, which was controversial at that time [20,21] . These countries originally had a low prevalence of hepatitis B infection, which may be related to the in ux of immigrants from other countries and regions [22] . Our results further illustrate the necessity for timely hepatitis B vaccination in all children.…”

The Age, Gamma-Glutamyl Transpeptidase and Platelet Index: A Novel Noninvasive Model for Predicting Hepatocellular Carcinoma in Patients with Hepatitis B Virus-Related Liver Cirrhosis

“… 6 Recent studies reported that the risk of HCC differs extensively across etiologies, age, and sex in patients with cirrhosis. 25 , 26 Thus, HCC surveillance in elderly patients with HBV or HCV-related LC is imperative. NSSs, including APRI, GPR, FIB-4, is a risk factor for HCC development in patients with CHB and fatty liver disease.…”