Increasing co-morbidities in chronic hepatitis B patients: experience in primary care and referral practices during...

Data on liver and non-liver co-morbidities in chronic hepatitis B (CHB) patients are limited. This study analyzes the prevalence of co-morbidities in a multicenter CHB cohort evaluated over 15 years.

This study included 2734 consecutive adult American CHB patients from a university medical center and several community primary care clinics. Data were analyzed by time periods (patients in each time period were unique without overlapping): 2000-2005 (n = 885), 2006-2010 (n = 888), and 2011-2015 (n = 961). Patients were identified via electronic query using diagnosis code with data confirmed and extracted via individual chart review. Most patients were male (57.9%) and Asian (89.6%).

Mean age increased significantly from 43.3 ± 13.4 years during 2000-2005 to 49.1 ± 14.4 during 2011-2015 (p < 0.001). Between 2000-2005 and 2011-2015, fatty liver disease among new CHB patients increased from 1.6 to 6.8% (p < 0.001). Advanced liver diseases also increased (p < 0.001): cirrhosis (12.6-24.6%), hepatic decompensation (1.1-7.9%), and hepatocellular carcinoma (HCC) (4.9-9.1%). Similar trends were observed for non-liver co-morbidities (p < 0.001). Specifically, diabetes increased almost fivefold (4.9-22.9%), hypertension increased threefold (12.3-36.1%) and chronic kidney disease increased 4.5-fold (4.4-19.7%). Prevalence of osteopenia and osteoporosis also increased in CHB patients: 5.4-13.4% (p < 0.001) and 2.9-8.7% (p < 0.001), respectively. These trends were observed in both liver clinics and primary care clinics (except for advanced liver disease), treated and untreated patients, and for both sexes.

The CHB patient population is aging and now presents with significantly more co-morbidities. Early diagnosis and linkage to care is needed to prevent and mitigate liver as well as non-liver co-morbidities.