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Diagnosis Rates of Chronic Hepatitis B in Privately Insured Patients in the United States.
JAMA Netw Open. 2020 Apr 01; 3(4):e201844.JN

Abstract

Importance

To achieve the World Health Organization goal of viral hepatitis elimination by 2030, it is important to estimate current rates of chronic hepatitis B (CHB) diagnosis and treatment.

Objective

To provide an accurate accounting of the number of patients with CHB aged 6 years or older who have not yet been diagnosed in the United States.

Design, Setting, and Participants

This cross-sectional study used the commercial US Truven Health MarketScan Database (138 634 154 privately insured individuals in January 2007 to December 2014) to identify patients with CHB diagnosis and the National Health and Nutrition Examination Survey to estimate the actual number of privately insured persons with CHB. Based on sex and age distribution derived from the US Census Bureau, we calculated the total population with CHB and the proportion of those who remained undiagnosed among the 198 073 302 privately insured individuals. Next, we identified diagnosed CHB patients who received 1 or more prescription for CHB medications to calculate the treatment rate for those with severe disease states, such as cirrhosis and hepatocellular carcinoma, that would warrant treatment. Analyses were performed from October 2017 to January 2020.

Main Outcomes and Measures

The rate and number of patients with CHB who remained undiagnosed and treatment rates for patients with CHB who have cirrhosis or hepatocellular carcinoma.

Results

Among the 198 073 302 privately insured individuals (48.55% male; 15.52% aged 6-17 years; 84.48% aged ≥18 years), there were 511 029 (95% CI, 317 733-704 325) individuals with CHB, but only 95 075 of these had been diagnosed, yielding a diagnosis rate of only 18.60% (95% CI, 13.50%-29.92%), meaning that 81.40% (95% CI, 70.08%-86.50%) were undiagnosed. The treatment rates were 34.79% (95% CI, 33.31%-36.27%) for those with cirrhosis and 48.64% (95% CI, 45.59%-51.69%) for those with hepatocellular carcinoma.

Conclusions and Relevance

In this study, only approximately 1 in 5 privately insured patients with CHB had been diagnosed. Only one-third of patients with CHB who had cirrhosis and one-half who had hepatocellular carcinoma received antiviral therapy. Further efforts are needed to improve the current situation of poor connection to care for patients with CHB, especially for those with advanced liver disease.

Authors+Show Affiliations

Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, California. Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan.Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, California.Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, California.Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, California.Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, California.Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, California.Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, California.Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, California. Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, California.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32271388

Citation

Ogawa, Eiichi, et al. "Diagnosis Rates of Chronic Hepatitis B in Privately Insured Patients in the United States." JAMA Network Open, vol. 3, no. 4, 2020, pp. e201844.
Ogawa E, Yeo YH, Dang N, et al. Diagnosis Rates of Chronic Hepatitis B in Privately Insured Patients in the United States. JAMA Netw Open. 2020;3(4):e201844.
Ogawa, E., Yeo, Y. H., Dang, N., Le, M. H., Jeong, D., Tran, S., Henry, L., Cheung, R., & Nguyen, M. H. (2020). Diagnosis Rates of Chronic Hepatitis B in Privately Insured Patients in the United States. JAMA Network Open, 3(4), e201844. https://doi.org/10.1001/jamanetworkopen.2020.1844
Ogawa E, et al. Diagnosis Rates of Chronic Hepatitis B in Privately Insured Patients in the United States. JAMA Netw Open. 2020 Apr 1;3(4):e201844. PubMed PMID: 32271388.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnosis Rates of Chronic Hepatitis B in Privately Insured Patients in the United States. AU - Ogawa,Eiichi, AU - Yeo,Yee Hui, AU - Dang,Nolan, AU - Le,Michael H, AU - Jeong,Donghak, AU - Tran,Sally, AU - Henry,Linda, AU - Cheung,Ramsey, AU - Nguyen,Mindie H, Y1 - 2020/04/01/ PY - 2020/4/10/entrez PY - 2020/4/10/pubmed PY - 2020/4/10/medline SP - e201844 EP - e201844 JF - JAMA network open JO - JAMA Netw Open VL - 3 IS - 4 N2 - Importance: To achieve the World Health Organization goal of viral hepatitis elimination by 2030, it is important to estimate current rates of chronic hepatitis B (CHB) diagnosis and treatment. Objective: To provide an accurate accounting of the number of patients with CHB aged 6 years or older who have not yet been diagnosed in the United States. Design, Setting, and Participants: This cross-sectional study used the commercial US Truven Health MarketScan Database (138 634 154 privately insured individuals in January 2007 to December 2014) to identify patients with CHB diagnosis and the National Health and Nutrition Examination Survey to estimate the actual number of privately insured persons with CHB. Based on sex and age distribution derived from the US Census Bureau, we calculated the total population with CHB and the proportion of those who remained undiagnosed among the 198 073 302 privately insured individuals. Next, we identified diagnosed CHB patients who received 1 or more prescription for CHB medications to calculate the treatment rate for those with severe disease states, such as cirrhosis and hepatocellular carcinoma, that would warrant treatment. Analyses were performed from October 2017 to January 2020. Main Outcomes and Measures: The rate and number of patients with CHB who remained undiagnosed and treatment rates for patients with CHB who have cirrhosis or hepatocellular carcinoma. Results: Among the 198 073 302 privately insured individuals (48.55% male; 15.52% aged 6-17 years; 84.48% aged ≥18 years), there were 511 029 (95% CI, 317 733-704 325) individuals with CHB, but only 95 075 of these had been diagnosed, yielding a diagnosis rate of only 18.60% (95% CI, 13.50%-29.92%), meaning that 81.40% (95% CI, 70.08%-86.50%) were undiagnosed. The treatment rates were 34.79% (95% CI, 33.31%-36.27%) for those with cirrhosis and 48.64% (95% CI, 45.59%-51.69%) for those with hepatocellular carcinoma. Conclusions and Relevance: In this study, only approximately 1 in 5 privately insured patients with CHB had been diagnosed. Only one-third of patients with CHB who had cirrhosis and one-half who had hepatocellular carcinoma received antiviral therapy. Further efforts are needed to improve the current situation of poor connection to care for patients with CHB, especially for those with advanced liver disease. SN - 2574-3805 UR - https://www.unboundmedicine.com/medline/citation/32271388/Diagnosis_Rates_of_Chronic_Hepatitis_B_in_Privately_Insured_Patients_in_the_United_States_ L2 - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2020.1844 DB - PRIME DP - Unbound Medicine ER -
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