Long-term morbidity and mortality in Chinese insurance applicants infected with the hepatitis B virus

Worldwide, there are approximately 350 million carriers of the hepatitis B virus (HBV). The protracted course of HBV infection makes it difficult to estimate morbidity and mortality risk in an insured lives population that is chronically infected with HBV because most studies on this topic have been based on older patients with advanced disease who were treated at tertiary centers that specialize in care of patients with liver disease. Data from these reports bias risk estimates toward severe cases and are not appropriate indicators of what might be expected in an insurance context. This article discusses use of a Markov model to estimate long-term morbidity and mortality risk associated with chronic HBV infection in otherwise healthy Chinese insurance applicants.

The model was validated by comparing results to population data published in Taiwan, Hong Kong, Shanghai, Singapore, and Korea. For males, mortality ratios were in the range of 150-175% for underwriting ages 20, 30, and 40 and slightly lower for age 50. For females, mortality ratios were in the range of 125-150% and slightly higher for age 50. Higher mortality ratios in males were related to the fourfold higher hepatocellular carcinoma (HCC) incidence rate. Mortality ratios varied with the extent of the underwriting evaluation. Liver-related morbidity incidence increased with age at underwriting for males and females. HBeAg (hepatitis B "e" antigen)/anti-HBe status was not a major factor for differentiating risk in an insurance context.

Morbidity and mortality are within the insurable range for the majority of HBV-infected Chinese applicants. Risk varies with the extent of the underwriting evaluation and the percentage of applicants with significant liver fibrosis or early cirrhosis that are detected during the underwriting process. HBeAg/anti-HBe status is not a major factor for differentiating risk in an insurance context. Morbidity and mortality estimates provided by the model can be generalized to other populations and individuals where HBV infection occurs at birth or during early childhood, although some modification in insurance risk might be required in non-Asian markets.