Pitfalls in measuring temporal trends for late diagnosis of viral hepatitis

Lapointe‐Shaw, Lauren; Austin, Peter C.; Chung, Hannah; Sander, Beate; Kwong, Jeffrey C.; Feld, Jordan J.

doi:10.1016/j.jhep.2019.06.015

Cited by 4 publications

(7 citation statements)

References 8 publications

(15 reference statements)

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“…Bias can result from this approach if there are differences in the length of observation time for those diagnosed with complications in earlier years vs later years. As we have previously described, such bias may account for the finding of a decreasing trend in late diagnosis over time 28 . The administrative algorithms used in these studies to identify decompensation events also differed from ours, yet this would not account for such a marked difference in trends over time.…”

Section: Discussionmentioning

confidence: 58%

Peri‐complication diagnosis of hepatitis C infection: Risk factors and trends over time

Lapointe‐Shaw

Chung²,

Sander

et al. 2020

Liver International

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Background & Aims: Hepatitis C virus (HCV) is a common and treatable cause of cirrhosis and its complications, yet many chronically infected individuals remain undiagnosed until a late stage. We sought to identify the frequency of and risk factors for HCV diagnosis peri-complication, that is within six months of an advanced liver disease complication. Methods: This was a retrospective cohort study of Ontario residents diagnosed with chronic HCV infection between 2003 and 2014. HCV diagnosis peri-complication was defined as the occurrence of decompensated cirrhosis, hepatocellular carcinoma or liver transplant within ±6 months of HCV diagnosis. Multivariable logistic regression was used to identify risk factors for peri-complication diagnosis among all those diagnosed with HCV infection. Results: Our cohort included 39,515 patients with chronic HCV infection, of whom 4.2% (n = 1645) were diagnosed peri-complication; these represented 31.6% of the 5,202 patients who developed complications in the follow-up period. Peri-complication diagnosis became more common over the study period and was associated with increasing age among baby boomers, alcohol use, diabetes mellitus, chronic HBV co-infection and moderate to high levels of morbidity. Female sex, immigrant status, having more previous outpatient physician visits, a previous emergency department visit, a history of drug use or mental health visits were associated with reduced risk of peri-complication diagnosis.

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Section: Discussionmentioning

confidence: 58%

Peri‐complication diagnosis of hepatitis C infection: Risk factors and trends over time

Lapointe‐Shaw

Chung²,

Sander

et al. 2020

Liver International

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“…DC, HCC) (Approach 1) or HCV diagnosis (Approach 2) as the anchor point around which the outcome is assessed ( Table 1). The limitations of the former and strengths of the latter were highlighted in a recent letter by Lapointe-Shaw et al 2 These discussions are important for moving towards a more standardized approach to measuring late diagnosis.…”

Section: Limited Researchmentioning

confidence: 99%

“…The alternative approach adopted by Lapointe-Shaw and others 2,5,6 uses HCV diagnosis as the anchor and identifies complications within a specified time window around this date. The question asked here is broader: what proportion of all HCV cases are diagnosed at a late stage?…”

Section: Two Different Approachesmentioning

confidence: 99%

“…Misclassification may also arise if individuals die from HCVrelated liver complications before the complication is diagnosed by a physician. Use of death data to identify DC and HCC may therefore be important, but was not done in our original analysis or in other studies (with the exception of Lapointe-Shaw et al 2,7 ). In the current analysis described in this letter, inclusion of death codes did not affect trends but did increase the prevalence of late diagnosis in Approach 2 by 0.1-0.4% absolute percentage points (data not shown).…”

Section: Deathmentioning

confidence: 99%

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Reply to: “Pitfalls in measuring temporal trends for late diagnosis of viral hepatitis”

Wilton

Samji

et al. 2019

Journal of Hepatology

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Considerations for studying trends in late diagnosis of hepatitis C virus and its liver complications To the Editor: By the year 2030, the Global Health Sector Strategy on viral hepatitis aims to reduce mortality by 65% and new infections by 90%. Reaching these goals will require diagnosing 90% of people living with HCV and treating 80% of those diagnosed. However, since HCV infection remains asymptomatic until late stage complications manifest, diagnosis rates are concerningly low in many countries. Screening programs are intended to diagnose individuals in the asymptomatic phase and reduce late stage HCV diagnosis when decompensated cirrhosis (DC) or hepatocellular carcinoma (HCC) has already occurred. Monitoring trends in late diagnosis of HCV and its liver complications is an important indicator to evaluate the success of screening efforts and progress towards the strategy's goals.

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“…9 These cases of advanced liver disease, particularly the high point prevalence of HCC, highlight that late diagnosis is still a problem and speak to the importance of screening to allow for treatment before complications arise. 15 Continuing along the continuum, the treatment outcomes were also surprisingly good. Of viremic individuals, 91.2% received treatment through the ELRIAH program and the others, primarily government workers, were referred to government HCV treatment facilities.…”

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confidence: 95%

HCV elimination: It will take a village and then some

Feld

2020

Journal of Hepatology

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Pitfalls in measuring temporal trends for late diagnosis of viral hepatitis

Abstract: Minimum infectious dose of hepatitis B virus in chimpanzees and difference in the dynamics of viremia between genotype A and genotype C.

Cited by 4 publications

References 8 publications

Peri‐complication diagnosis of hepatitis C infection: Risk factors and trends over time

Peri‐complication diagnosis of hepatitis C infection: Risk factors and trends over time

Reply to: “Pitfalls in measuring temporal trends for late diagnosis of viral hepatitis”

HCV elimination: It will take a village and then some

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