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Chronic Hepatitis Cohort Study Sheds Light on Burden of Hepatitis B and C in U.S.

People born between 1945 and 1964 account for the highest proportion of hepatitis B and C cases, and these viruses are a significant cause of illness and death, according to an analysis described in the January 1, 2013, Clinical Infectious Diseases.

Over years or decades chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection can lead to advanced liver disease including cirrhosis (scarring) and hepatocellular carcinoma. Hepatitis B can be prevented with an effective vaccine, but complete cures are uncommon. Hepatitis C, in contrast, currently has no vaccine but treatment is increasingly effective at curing infection.

Approximately 1.25 million people in the U.S. are thought to carry chronic hepatitis B, while estimates for chronic hepatitis C fall with in the 3-4 million range. But the disease progression and the clinical implications of these viruses in the "real world" are not fully known.

To shed light on this issue, Anne Moorman from the Centers for Disease Control and Prevention (CDC) Division of Viral Hepatitis and fellow researchers with the Chronic Hepatitis Cohort Study (CHeCS) conducted an observational study using electronic medical records for more 1.6 million adult patients seen between January 2006 and December 2010 at 4 integrated healthcare systems in Detroit (Henry Ford Health System), Danville, PA (Geisinger Health System), Honolulu (Kaiser Permanente Hawaii), and Portland, OR (Kaiser Permanente Northwest).

Results

• Out of the full study population, 2202 people were found to have chronic hepatitis B and 8810 had chronic hepatitis C.
• Among thehepatitis B patients, 50% were in the 44-63 year age group, 57% were men, 58% were Asian or Pacific Islanders, 28% were white, and 13% were black.
• Among thehepatitis C patients, 75% were age 44-63 years, 60% were men, 70% were white, 23% were black, and 6% were Asian or Pacific Islanders.
• About one-quarter of the hepatitis C cohort had been tested for HIV, with a coinfection rate of 3%.
• Looking at insurance coverage, 5% of people with hepatitis B and 12% with hepatitis C relied on Medicaid; 17% and 23%, respectively, were on Medicare; and 76% and 62%, respectively, had private insurance.
• During 2001-2010, 22% of hepatitis B patients and 38% of hepatitis C patients underwent liver biopsy.
• During the same period 38% of hepatitis B patients and 44% of hepatitis C patients were hospitalized, or 9% and 13%, respectively, per year.
• Among people in care, 9% ofpeople with hepatitis B (21.6 per 1,000 person-years)and 14% of those with hepatitis C(33 per 1,000 person-years)died during the 2006-2010 follow-up period -- most of them "Baby Boomers" born during 1945-1964.
• Looking at the 2 healthcare systems with transplant centers (Detroit and Danville), about 2% of hepatitis B patients and 5% with hepatitis C underwent liver transplantation due to end-stage liver disease.

Based on these findings, the study authors concluded, "Baseline demographics, hospitalization, and mortality data from CHeCS highlight the substantial U.S. health burden from chronic viral hepatitis, particularly among persons born during 1945-1964."

In their discussion the researchers noted that all-cause death rates among people with hepatitis C in CHeCS was 3-fold higher than the rate for the general population in the National Health and Nutrition Examination Survey or NHANES (33% vs 11%, respectively). Furthermore, CHeCS participants died at a comparatively young age.

The researchers said that their findings "strongly support" a policy of birth cohort screening for people born between 1945 and 1964. Last May the CDC recommendedthat everyone born during this period should get tested for HCV at least once, regardless of risk factors, but in December the U.S. Preventive Services Task Force advised only that people in this group should "consider" testing unless they were at known risk.

"Therapies for chronic viral hepatitis are likely to improve substantially over the coming years," but "[t]reatment results in clinical practice do not always mirror those in the clinical trial setting, particularly among minority and low-income patients with many barriers to care," the authors wrote.

The CHeCS study is ongoing with newly added participants, and the researchers will be looking at how factors such as smoking, substance use, and overall well-being can affect mortality, disease progression, treatment side effects, and drug resistance under "real-world" conditions.

2/1/13

Reference

AC Moorman, SC Gordon, LB Rupp. Baseline Characteristics and Mortality among People in Care for Chronic Viral Hepatitis: The Chronic Hepatitis Cohort Study. Clinical Infectious Diseases 56(1):40-50. January 1, 2013.