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Published on: December 15, 2023
Racial Disparities in Treatment Initiation and Outcomes of Chronic Hepatitis B Virus Infection in North America
Mandana Khalili1, Kelsey R Leonard2, Marc G Ghany3
1Division of Gastroenterology and Hepatology, University of California, San Francisco.
Insights
Racial disparities exist in chronic hepatitis B virus (HBV) treatment initiation, with Black or African American individuals less likely to meet criteria. However, treatment receipt was similar among those eligible, and adverse liver outcomes were rare across all groups.
Area of Science:
- Hepatology
- Infectious Diseases
- Public Health
Background:
- Limited data exist on racial disparities in treatment initiation and outcomes for chronic hepatitis B virus (HBV) infection.
- Understanding these disparities is crucial for equitable patient care and improved health outcomes.
Purpose of the Study:
- To investigate differences in HBV treatment initiation and clinical outcomes among diverse racial groups.
- To identify potential barriers or facilitators to treatment access and adherence.
Main Methods:
- A multicenter longitudinal cohort study (Hepatitis B Research Network [HBRN] adult cohort study) enrolled HBV-positive adults in North America.
- Data on sociodemographics, virologic parameters, treatment initiation, and major adverse liver outcomes were collected over a median follow-up of 41.2 years.
- Statistical analyses compared treatment initiation rates and outcomes across racial groups, including African American or Black, Asian, and White participants.
Main Results:
- African American or Black participants were less likely to meet HBV treatment criteria compared to Asian and White individuals (14% vs. 22-27%).
- Incidence of treatment initiation varied by race (4.8-9.9 per 100 person-years), but cumulative probabilities of treatment initiation after meeting criteria were similar across groups.
- Major adverse liver outcomes were rare (0.1 per 100 person-years) and did not differ significantly by race.
Conclusions:
- While African American or Black individuals were less likely to meet HBV treatment criteria, those who did initiated treatment at similar rates to other racial groups.
- Adverse liver outcomes were infrequent in this cohort, suggesting effective management or a low-risk population.
- Findings highlight the need to address criteria for treatment initiation to reduce racial disparities in chronic HBV care, though generalizability may be limited to similar healthcare settings.
Importance:
Disparities in treatment initiation may affect outcomes, but data on racially diverse populations with chronic hepatitis B virus (HBV) infection are limited.
Objective:
To examine whether HBV treatment initiation and outcomes differ among racial groups.
Design, Setting, And Participants:
From January 14, 2011, to January 28, 2018, hepatitis B surface antigen-positive adults (age ≥18 years) not receiving anti-HBV therapy were enrolled and followed up at weeks 12, 24, and every 24 weeks thereafter in a multicenter longitudinal cohort study (Hepatitis B Research Network [HBRN] adult cohort study) conducted in North America. The last study visit and data collection were completed January 28, 2019. Data were analyzed from August 27, 2021, to August 25, 2022. All HBRN participants were included unless they had acute HBV, HIV, hepatitis C or D, less than 24-weeks of follow-up after enrollment, initiated treatment at or immediately after enrollment, or had unknown race.
Exposures:
Participants had clinical and laboratory assessments and could receive anti-HBV treatment after enrollment.
Main Outcomes And Measures:
Hepatitis B virus treatment initiation and major adverse liver outcomes (hepatic decompensation, hepatocellular carcinoma, liver transplant, and death).
Results:
Of 1550 participants, 193 (12%) were African American or Black, 1157 (75%) were Asian, 157 (10%) were White, and 43 (3%) were other races; 789 (51%) were women, and the median age was 41.2 (IQR, 32.9-51.6) years. Sociodemographic and virologic parameters differed between groups. During 5727 person-years of follow-up, 504 participants initiated treatment, with incidences of 4.8 per 100 person-years in African American or Black individuals, 9.9 per 100 person-years in Asian individuals, 6.6 per 100 person-years in White individuals, and 7.9 per 100 person-years in those of other races (P < .001). A lower proportion (14%) of African American or Black participants met treatment criteria compared with Asian (22%) and White (27%) individuals (P = .01). The cumulative probabilities of treatment initiation after meeting the criteria were not significantly different among racial groups (African American or Black, 0.45; Asian, 0.38; White, 0.40 at 48 weeks and African American or Black, 0.45; Asian, 0.51; White, 0.51 at 72 weeks; P = .68). The incidence of major adverse liver outcomes was 0.1 per 100 person-years and did not differ by race.
Conclusions And Relevance:
In this observational study of chronic HBV, African American or Black participants were less likely than individuals of other races to meet treatment criteria, but among those who did, HBV treatment receipt did not differ significantly by race or socioeconomic factors. Not all eligible participants initiated treatment, but adverse liver outcomes were rare. These findings may not be generalizable to patients with chronic HBV receiving care in other settings.
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