Evidence for the insufficient evaluation and undertreatment of chronic hepatitis B infection in a predominantly low-income and immigrant population

• Published in: Journal of gastroenterology and hepatology Vol. 25; no. 2; pp. 369 - 375
• Main Authors: Jung, Chin W, Tan, Jennifer, Tan, Nelly, Kuo, Melissa N, Ashok, Ashwin, Eells, Samantha J, Miller, Loren G
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Publishing Asia 01.02.2010; Wiley-Blackwell
• Subjects: Adult; Antiviral Agents - therapeutic use; Biological and medical sciences; Biopsy; California - epidemiology; Diagnostic Tests, Routine - statistics & numerical data; DNA, Viral - blood; Emigrants and Immigrants - statistics & numerical data; evaluation; Female; Gastroenterology. Liver. Pancreas. Abdomen; Health Services Accessibility - statistics & numerical data; Healthcare Disparities; hepatitis B; Hepatitis B Surface Antigens - blood; hepatitis B virus; Hepatitis B virus - genetics; Hepatitis B virus - immunology; Hepatitis B, Chronic - diagnosis; Hepatitis B, Chronic - epidemiology; Hepatitis B, Chronic - therapy; HIV Infections - epidemiology; Human viral diseases; Humans; Infectious diseases; Logistic Models; Male; Medical sciences; Middle Aged; Odds Ratio; Poverty - statistics & numerical data; Practice Patterns, Physicians' - statistics & numerical data; Risk Assessment; Risk Factors; treatment; Treatment Outcome; Viral diseases; Viral hepatitis; Virus Replication; California; Immigrant; hepatitis B; Orthohepadnavirus; Hepatic disease; Infection; Virus; Viral hepatitis B; evaluation; Treatment; Hepadnaviridae; Viral disease; Gastroenterology; Digestive diseases; Hepatitis B virus
• ISSN: 0815-9319; 1440-1746
• DOI: 10.1111/j.1440-1746.2009.06023.x

Background and Aim:  Many physicians remain unaware of contemporary treatments for chronic hepatitis B (HBV) infection and do not treat their HBV‐infected patients or refer them for treatment. The aim of the present study was to determine the rates of laboratory evaluation and treatment of HBV infection in a predominantly low‐income and immigrant population. Methods:  We identified adult patients who tested positive for hepatitis B surface antigen between 1 January 1994 and 30 April 2006. We reviewed patients' medical records to determine two outcomes: (i) receipt of pretreatment evaluation of HBV infection; and (ii) receipt of HBV treatment. We then examined clinical and demographic factors associated with these outcomes. Results:  Twenty‐eight percent of 1231 HBV surface antigen‐positive patients received additional laboratory evaluation of their infection. In a multivariate analysis, receipt of a HBV evaluation was independently associated with (P < 0.05) female sex, longer duration of HBV infection, more visits to a gastroenterology clinic and less recent health‐care contact. Data on treatment were available for 56% of patients; among these, 16% received HBV treatment. In the multivariate analysis, receipt of HBV treatment was independently associated with (P < 0.05) HIV co‐infection, receipt of liver biopsy, testing for hepatitis B e antigen or HBV DNA, longer duration of HBV infection, more visits to a gastroenterology clinic and more recent health‐care contact. When excluding HIV‐infected patients, only 10% of patients received HBV treatment. Conclusions:  After the diagnosis of HBV infection, few patients in our population received laboratory evaluation to determine eligibility for HBV treatment. Furthermore, only a small percentage received HBV treatment. Further research needs to be done to validate these findings in other populations and understand barriers to receiving HBV treatment.