High Prevalence of Cirrhosis at Initial Presentation Among Safety-Net Adults with Chronic Hepatitis B Virus Infection

Tang, Elaine; Torres, Sharon; Liu, Benny; Baden, Rachel; Bhuket, Taft; Wong, Robert J.

doi:10.1016/j.jceh.2017.11.009

Cited by 12 publications

(21 citation statements)

References 23 publications

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“…Hepatitis B virus (HBV) infection is the main cause of HCC in the endemic regions of Asia, and the leading cause of morbidity and mortality worldwide with over 250 million people . Chronic HBV‐infected persons may have a 5‐ to 100‐fold increase in the risk of developing HCC .…”

Section: Hepatitis B Virus Infectionmentioning

confidence: 99%

Assessment of risk factors, and racial and ethnic differences in hepatocellular carcinoma

et al. 2020

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Despite improved screening and surveillance guidelines, significant race/ethnicity‐specific disparities in hepatocellular carcinoma (HCC) continue to exist and disproportionately affect minority and disadvantaged populations. This trend indicates that social determinants, genetic, and environmental factors are driving the epidemic at the population level. Race and geography had independent associations with risk of mortality among patients with HCC. The present review discusses the risk factors and issues related to disparities in HCC. The underlying etiologies for these disparities are complex and multifactorial. Some of the risk factors for developing HCC include hepatitis B (HBV) and hepatitis C (HCV) viral infection, nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, smoking and alcohol consumption. In addition, population genetics; socioeconomic and health care access; treatment and prevention differences; and genetic, behavioral, and biological influences can contribute to HCC. Acculturation of ethnic minorities, insurance status, and access to health care may further contribute to the observed disparities in HCC. By increasing awareness, better modalities for screening and surveillance, improving access to health care, and adapting targeted preventive and therapeutic interventions, disparities in HCC outcomes can be reduced or eliminated.

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Section: Hepatitis B Virus Infectionmentioning

confidence: 99%

Assessment of risk factors, and racial and ethnic differences in hepatocellular carcinoma

et al. 2020

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“…The authors of this study noted a few limitations in their analysis, specifically that their sample included largely uninsured and underinsured patients drawn from a safety net health care system that were referred for specialty gastroenterology care. These differences likely underlie the higher rate of cirrhosis observed among their population compared with our own 4. We note that the dynamic sampling design employed to generate our cohort is intended to increase the generalizability of our results by enrolling a random subset of CHB patients seen at our study sites.…”

Section: Discussionmentioning

confidence: 99%

“…These differences likely underlie the higher rate of cirrhosis observed among their population compared with our own. 4 We note that the dynamic sampling design employed to generate our cohort is intended to increase the generalizability of our results by enrolling a random subset of CHB patients seen at our study sites.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with chronic hepatitis B (CHB) infection are at risk of a number of serious long-term outcomes—including cirrhosis and liver-related mortality 1. Although these outcomes are well-described by natural history studies2,3 and point-prevalence studies within defined cohorts,4,5 there are remarkably few longitudinal analyses of trends in CHB-related cirrhosis and mortality—and none in the United States.…”

mentioning

confidence: 99%

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Trends in Cirrhosis and Mortality by Age, Sex, Race, and Antiviral Treatment Status Among US Chronic Hepatitis B Patients (2006-2016)

Lü¹,

Li²,

Zhou³

et al. 2021

Journal of Clinical Gastroenterology

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Background: Changing US demographics and evolving chronic hepatitis B (CHB) treatments may affect longitudinal trends in CHB-related complications. We studied trends in the prevalence of cirrhosis (past or present) and incidence of all-cause mortality, stratified by patient age, sex, race, and antiviral treatment status, in a sample from US health care systems. Methods: Joinpoint and Poisson regression (univariate and multivariable) were used to estimate the annual percent change in each outcome from 2006 to 2016. Results: Among 5528 CHB patients, cirrhosis prevalence (including decompensated cirrhosis) rose from 6.7% in 2006 to 13.7% in 2016; overall mortality was unchanged. Overall rates of cirrhosis and mortality were higher among treated patients, but adjusted annual percent changes (aAPC) were significantly lower among treated than untreated patients (cirrhosis: aAPC +2.4% vs. +6.2%, mortality: aAPC −3.9% vs. +4.0%). Likewise, among treated patients, the aAPC for mortality declined −3.9% per year whereas among untreated patients, mortality increased +4.0% per year. Conclusions: From 2006 to 2016, the prevalence of cirrhosis among CHB patients doubled. Notably, all-cause mortality increased among untreated patients but decreased among treated patients. These results suggest that antiviral treatment attenuates the progression of cirrhosis and the risk of death among patients with CHB.

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“…[15][16][17] Although care coordination is a universal problem, it is critical to address barriers for underinsured and uninsured patients coping with competing demands, increased medical complexity, and substantial social and economic barriers who often seek care in safety-net systems. [18][19][20] Few studies have focused on delineating system factors related to delivering coordinated care to underinsured and uninsured cancer survivors. To address this gap, we describe challenges and opportunities for improving care for cancer survivors with chronic conditions.…”

Section: Introductionmentioning

confidence: 99%

Thematic Analysis of Challenges of Care Coordination for Underinsured and Uninsured Cancer Survivors With Chronic Conditions

et al. 2021

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Key Points Question What are the barriers to coordinating care for underinsured and uninsured patients with cancer and chronic conditions during and after cancer treatment at a safety-net health system? Findings This qualitative study of interviews and observation of 93 health system stakeholders identified system-level challenges (ie, challenges to accessing primary care, lack of communication between oncology and primary care clinicians, leadership awareness of care coordination challenges) and clinician-level challenges (ie, unclear role delineation, lack of clinician knowledge and preparedness to manage cancer and chronic conditions). Meaning These findings suggest that survivorship care delivery strategies that bridge oncology and primary care may be required to meet the care coordination needs of underinsured and uninsured patients with cancer amid the fragmented US health care system.

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High Prevalence of Cirrhosis at Initial Presentation Among Safety-Net Adults with Chronic Hepatitis B Virus Infection

Cited by 12 publications

References 23 publications

Assessment of risk factors, and racial and ethnic differences in hepatocellular carcinoma

Assessment of risk factors, and racial and ethnic differences in hepatocellular carcinoma

Trends in Cirrhosis and Mortality by Age, Sex, Race, and Antiviral Treatment Status Among US Chronic Hepatitis B Patients (2006-2016)

Thematic Analysis of Challenges of Care Coordination for Underinsured and Uninsured Cancer Survivors With Chronic Conditions

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