Kaiser Permanente Division of Research, CA, United States
Mai Sedki, MD, MPH1, Brandon Horton, MPH2, Andrew Avins, MD, MPH2, Douglas Corley, MD, PHD2, Krisna Chai, MD3, Joanna Ready, MD4 1Kaiser Permanente Division of Research, Lincoln, CA; 2Kaiser Permanente Division of Research, Oakland, CA; 3Kaiser Permanente Medical Center, Santa Clara, CA; 4Kaiser Permanente Medical Center, Walnut Creek, CA
Introduction: Chronic hepatitis B virus (CHB) infection is a serious public health concern, the World Health Organization and the US Dept. of Health and Human Services have set a goal to eliminate all viral hepatitis by 2030. An ability to identify, track, and understand HBV prevalence and characteristics in general high-risk populations is critical to achieving this goal. Few population-based studies have characterized the demographics and clinical characteristics of CHB in the US. In this study, we demonstrate the feasibility and present the results of electronic medical record (EMR)-based ascertainment of CHB patients to support a dedicated surveillance program to describe the epidemiologic characteristics and treatment exposures of a large population-representative cohort of CHB patients within Northern California (NC).
Methods: Kaiser Permanente Northern California (KPNC) is a large integrated health plan serving 4.5 million members (~31% of the insured population in NC). For this study, CHB was defined as Hepatitis B surface antigen (HBsAg) positivity for greater than 6 months; all adults with CHB from July 2009 - December 2019 (n=23074) were included. Basic demographics and clinical and laboratory characteristics were summarized using data extracted from the EMR.
Results: During the study period, 22486 patients with CHB were identified. Overall, 51% were men and 83% were Asian, with Chinese as the most frequent subcategory (49%). Among those identified with chronic HBV, 10.2% had cirrhosis and 0.37% had hepatocellular carcinoma (HCC). Among the 55% tested for the delta antigen, only 0.5% were known to be coinfected with HDV. Positive hepatitis B envelope antigen (HBeAg) was documented in 20%. The median AFP, total bilirubin, INR and platelet count were 2.5 ng/ml, 0.6 mg/dL, 1.0 and 227 per uL espectively. ALT levels were elevated in 11% ( >2 times the upper limit of normal) and HBV viral load was reported to be greater than 20,000 IU/ml in 18% of our cohort compared to 5% and 14% by the end of the study, respectively. In our cohort, 23% were prescribed HBV treatment at some point during their disease course with the most common initial treatment regimen being entecavir. HCC screening through CT, MRI or US was documented in 87% in our cohort.
Discussion: In this study, we show that a dedicated program can successfully identify CHB patients using electronic health data and demonstrate its use to characterize HBV epidemiology in a large representative cohort within an integrative health system.
Figure: CHB patient demographics and clinical characteristics.
Disclosures: Mai Sedki indicated no relevant financial relationships. Brandon Horton indicated no relevant financial relationships. Andrew Avins indicated no relevant financial relationships. Douglas Corley indicated no relevant financial relationships. Krisna Chai indicated no relevant financial relationships. Joanna Ready indicated no relevant financial relationships.
Mai Sedki, MD, MPH1, Brandon Horton, MPH2, Andrew Avins, MD, MPH2, Douglas Corley, MD, PHD2, Krisna Chai, MD3, Joanna Ready, MD4. P2805 - Demographics of Patients With Chronic Hepatitis B in an Integrated Care System, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
