Racial and Ethnic Disparities in Characteristics and Care Patterns of Chronic Hepatitis B Patients in the United States

Joanne K Liu; Leslie Y Kam; Daniel Q Huang; Linda Henry; Ramsey Cheung; Mindie H Nguyen

doi:10.1016/j.cgh.2023.01.035

Racial and Ethnic Disparities in Characteristics and Care Patterns of Chronic Hepatitis B Patients in the United States

Clin Gastroenterol Hepatol. 2023 Sep;21(10):2606-2615.e7. doi: 10.1016/j.cgh.2023.01.035. Epub 2023 Feb 11.

Authors

Joanne K Liu¹, Leslie Y Kam², Daniel Q Huang³, Linda Henry², Ramsey Cheung⁴, Mindie H Nguyen⁵

Affiliations

¹ University of Washington, Seattle, Washington; Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California.
² Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California.
³ Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, National University Health System, Singapore.
⁴ Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California; Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
⁵ Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California; Department of Epidemiology and Population Health, Stanford University Medical Center, Palo Alto, California. Electronic address: mindiehn@stanford.edu.

PMID: 36781005
DOI: 10.1016/j.cgh.2023.01.035

Abstract

Background & aims: Chronic hepatitis B (CHB) disproportionately impacts foreign-born patients and those of Asian or Black race. Given the paucity of data, we aimed to study the impact of race and ethnicity on CHB patient characteristics and management.

Methods: A retrospective analysis of adult CHB patients using data recorded in the deidentified Optum Clinformatics Data Mart Database (January 2003‒March 2021) was performed. We characterized and examined the rates of receiving adequate treatment evaluation (measuring hepatitis B virus DNA and alanine transaminase) and hepatitis B virus treatment among the racial and ethnic groups.

Results: The study cohort included 42,140 patients: age, 51.9 ± 15.1 years; 56.1% male; 47% Asian; 26% White; 11% Black; and 7% Hispanic. Thirty-three percent of White and 48% of Asian patients had an annual household income greater than $100,000 US compared with 16% for Black and 25% for Hispanic patients (P < .001), with similar disparities in educational levels. Approximately one third of White (29.3%), Black (35.1%), and Hispanic (35.4%), and half of Asian (49.9%) patients received adequate evaluation (P < .001). Among patients who met American Association for the Study of Liver Diseases treatment criteria, treatment rates were similar among White (60.8%; P = .09) and Black (62.8%; P = .48), but lower among Hispanic (54.7%; P = .03), as compared with Asian patients (65.4%). On multivariable logistic regression adjusted for age, sex, provider type, viral co-infection, and fatty liver disease, Hispanic patients were less likely to receive treatment (adjusted hazard ratio, 0.69; 95% CI, 0.53‒0.91; P = .01) compared with Asian patients.

Conclusions: Compared with Asian CHB patients, non-Asian patients were less likely to undergo adequate evaluation and Hispanic patients were less likely to receive treatment for CHB. Additional efforts are needed to improve CHB management, especially for non-Asian patients.

Keywords: Care Gaps; Linkage to Care; Socioeconomic; Under-represented Minorities.

MeSH terms

Adult
Aged
Black or African American
Ethnicity
Female
Hepatitis B, Chronic* / therapy
Humans
Male
Middle Aged
Retrospective Studies
United States / epidemiology
White