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

Burrow

et al. 2022

Preprint

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BackgroundHBV is the leading global cause of cirrhosis and primary liver cancer. The virus’s attributable disease burden in the UK is concentrated in vulnerable populatons including ethinic minorities, people experiencing homelessness and people born in high-prevalence countries. Despite this the UK HBV population has not been well characterised, and estimates of UK HBV prevalence and/or positivity rate vary widely across sources. We summarised datasets that are available to represent UK CHB epidemiology, consider differences between sources, and discuss deficiencies in current estimates.MethodsWe searched for estimates of CHB case numbers in the UK (incorporating incidence and/or prevalence-like data) across a range of available sources, including UK-wide reports from government bodies, publications from independent bodies (including medical charities and non-governmental organisations) and articles in peer-reviewed scientific journals. We present positivity rates from each respective data source but caution that estimates may not be representative of the true UK-wide population prevalence.Results and DiscussionSix CHB case number estimates were identified, with three estimates reporting information concerning population subgroups, including number of infected individuals across age, sex and ethnicity categories., Estimates among sources reporting prevalence varied from 0.27% to 0.73%. An alterantive proxy for population prevalence (obtained via the UK antenatal screening programme which achieves over 95% coverage of every pregnant woman) estimated a CHB prevalence of <0.5%. Estimates varied by sources of error, bias and missingness, data linkage, and substantial “blind spots” in consistent testing and registration of HBV diagnoses. Multi-parameter evidence synthesis and back-calculation model methods similar to those used to generate estimates of HCV ad HIV population-wide prevalence may be applicable to HBV.

Section: Resultsmentioning

confidence: 99%

Estimating the epidemiology of chronic Hepatitis B Virus (HBV) infection in the UK: what do we know and what are we missing?

Burrow

et al. 2022

Preprint

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“…In our sample, 12% of individuals initiated antiviral treatment during follow-up. However, treatment data are most comprehensively captured in secondary/tertiary care records where HBV prescribing is based (60). In the NIHR Health Informatics Collaborative (HIC) secondary care EHR database, 16% of CHB patients were receiving antiviral treatment (61).…”

Section: Discussionmentioning

confidence: 99%

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

Gillespie

et al. 2022

Preprint

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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.

“…We undertook longitudinal and cross-sectional analyses using routinely-collected individual-level secondary care data collected across five NHS Trusts in England by the National Institute for Health Research (NIHR) Health Informatics Collaborative (HIC), as previously described 9,10 . HBV treatment data were available from three NHS Trusts.…”

Section: Methodsmentioning

confidence: 99%

Impact of the COVID-19 pandemic on routine surveillance for adults with chronic hepatitis B virus (HBV) infection in the UK

Smith³

et al. 2022

Wellcome Open Res

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Background: To determine the impact of the COVID-19 pandemic on the population with chronic Hepatitis B virus (HBV) infection under hospital follow-up in the UK, we quantified the coverage and frequency of measurements of biomarkers used for routine surveillance (alanine transferase [ALT] and HBV viral load). Methods: We used anonymized electronic health record data from the National Institute for Health Research (NIHR) Health Informatics Collaborative (HIC) pipeline representing five UK National Health Service (NHS) Trusts. Results: We report significant reductions in surveillance of both biomarkers during the pandemic compared to pre-COVID-19 years, both in terms of the proportion of patients who had ≥1 measurement annually, and the mean number of measurements per patient. Conclusions: These results demonstrate the real-time utility of HIC data in monitoring health-care provision, and support interventions to provide catch-up services to minimise the impact of the pandemic. Further investigation is required to determine whether these disruptions will be associated with increased rates of adverse chronic HBV outcomes.