Chronic Hepatitis B Tied to Older Age, Comorbidities, and Chronic Kidney Disease

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Insured individuals with chronic hepatitis B have more comorbidities, are older, and have a greater incidence of chronic kidney disease than those not infected.
Insured individuals with chronic hepatitis B have more comorbidities, are older, and have a greater incidence of chronic kidney disease than those not infected.

Insured individuals with chronic hepatitis B have more comorbidities, are older, and have a greater incidence of chronic kidney disease than controls, according to a study recently published in Hepatology.

This retrospective, observational study included the records of 44,026 individuals with chronic hepatitis B who were covered by commercial insurance/Medicare (n=32,523) or by Medicaid (n=11,503). It also included 121,568 controls matched to the same criteria for continuous insurance coverage on both commercial insurance/Medicare (n=91,132) and Medicaid (n=30,436).

The mean age of individuals with chronic hepatitis B rose between 2006 and 2015 from 48.1±11.9 to 51.8±12.4 for individuals with commercial insurance/Medicare (P <.001), while a similar rise from 44.1±11.1 to 50.2±10.2 was observed for those on Medicaid (P <.001). Those with chronic hepatitis B on Medicaid were sicker than those on commercial insurance/Medicare (Deyo-Charlson comorbidity index=2.6; P <.001).

Within the commercial insurance/Medicare cohort, the prevalence rate for chronic kidney disease in 2006 was 36.1 per 1000 (compared with 10.2 per 1000 among controls), which rose to 97.6/1000 in 2016 (38.8/1000 among controls). In 2006, the incidence of chronic kidney disease was 10.3/1000 person-years (4.8, controls), while in 2015 it was 15.2/1000 person-years (11.3, controls; P <.05).

Hypertension was the strongest predictor of chronic kidney disease (hazard ratio [HR], 3.29), followed by diabetes mellitus (HR, 2.48) and cardiovascular disease (HR, 2.61; P <.0001). Osteoporosis/fracture showed similar rates, with the strongest predictors including being female (HR, 2.22), the use of alcohol (HR, 2.02), and a comorbid viral infection (HR, 1.37; P <.0001 for all).

Individuals included in the study were ≥18 years old, had chronic hepatitis B, had a minimum of 2 outpatient claims or 1 inpatient claim, and were enrolled continuously for at least 1 full year between 2006 and 2015. Fisher's exact tests and Asymptotic Pearson Chi-squared tests were used to compare categorical factors from the beginning and end of the study period. Analyses included both longitudinal and cross-sectional methods, and hazard ratios were constructed using Cox's proportional hazards regression models.

The study researchers conclude that “[insured] [chronic hepatitis B] patients were older with more comorbidities and experienced higher incidence and prevalence of [chronic kidney disease] and [osteoporosis/fracture] than controls.”

Disclosures: This study was funded by Gilead Sciences, who also played a role in designing and performing the study. Please refer to reference for a full list of authors' disclosures.

Reference

Nguyen MH, Lim JK, Ozbay AB, et al. Advancing age and comorbidity in a United States insured population-based cohort of patients with chronic hepatitis B [published online September 2, 2018]. Hepatology. doi: 10.1002/hep.30246

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