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Published on: December 15, 2023
Disease burden of chronic hepatitis B and C patients in South Korea: a population-based 16-year cohort study
Oeuk Jeong1,2, Changhee Chu1, Jungyeon Kim1
1Division of Clinical Research, National Institute of Infectious Diseases, Korea National Institute of Health, Cheongju, Republic of Korea.
Insights
Chronic hepatitis B and C virus (CHB/CHC) coinfection poses a significant disease burden and higher medical costs compared to single infections. Early screening and management strategies are crucial for public health in South Korea.
Area of Science:
- Hepatology
- Public Health
- Epidemiology
Background:
- The disease burden of chronic hepatitis B (CHB) and chronic hepatitis C (CHC) coinfection (CHB/CHC) requires elucidation.
- Previous studies have focused on individual hepatitis B and C infections, leaving the impact of coinfection understudied.
Purpose of the Study:
- To investigate the 16-year trend in disease burden among patients with CHB and/or CHC.
- To compare the progression to cirrhosis, hepatocellular carcinoma (HCC), and overall survival in patients with CHB, CHC, and CHB/CHC.
Main Methods:
- Analysis of a 16-year Korean National Health Insurance Service database (2002-2020).
- Evaluation of prevalence, cirrhosis and HCC development, and overall survival across CHB, CHC, and CHB/CHC groups.
- Comparison of direct medical costs associated with HCC diagnosis among the groups.
Main Results:
- CHB/CHC patients (3.3% of 747,476) exhibited higher risks of cirrhosis and HCC compared to CHC patients.
- Mortality risk was elevated in the CHB/CHC group compared to both CHB and CHC monoinfection groups.
- CHB/CHC patients incurred the highest average direct medical costs ($21,311) for HCC diagnosis.
Conclusions:
- CHB/CHC coinfection presents a substantial burden regarding disease progression and medical expenses compared to monoinfections.
- Effective screening strategies are essential for the early management of CHB/CHC to improve public health outcomes in South Korea.
Background:
The prevalence of chronic hepatitis B (CHB) and C viruses (CHC) has been studied widely, but the burden of CHB and CHC coinfection (CHB/CHC) remains to be elucidated. This study investigated the 16-year trend in the disease burden in patients with CHB and/or CHC.
Methods:
This analysis used a customized database from 2002 to 2020 obtained from the Korean National Health Insurance Service. Prevalence of CHB/CHC in patients with CHB and/or CHC was analyzed for each year, sex, and type of healthcare providers. Development of cirrhosis and hepatocellular carcinoma (HCC), and overall survival were evaluated.
Results:
A total of 747,476 patients (male: 53.5%) were divided into three groups: CHB (593,962; 79.5%), CHC (129,049; 17.3%), and CHB/CHC (24,465; 3.3%). Regarding age distribution, most patients were in their 30s to 60s across all groups (76.5%). Compared to patients in CHB/CHC group, those in CHC had significantly lower incidence of cirrhosis (CHB/CHC vs. CHC, adjusted hazard ratio [aHR] = 0.893, 95% confidence interval [CI] = 0.864-0.922) and HCC (aHR = 0.847, 95% CI = 0.809-0.886). The CHB and CHC groups had a lower risk of mortality compared to the CHB/CHC group. (CHB/CHC vs. CHB and CHC, aHR = 0.878 and 0.892, 95% CI = 0.852-0.905 and 0.864-0.922, respectively). CHB/CHC groups showed the highest average direct medical costs ($21,311) to HCC diagnosis compared to CHB ($19,685) and CHC ($17,650).
Conclusions:
CHB/CHC is burdensome in its disease progression risk and medical costs compared to monoinfection. An effective screening strategy for early management of CHB/CHC is warranted for public health in South Korea.
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