Sex and ethnic disparities in hepatitis B evaluation and treatment across the world.

Autor: Kudaravalli S; Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, United States; Trinity College of Arts and Sciences, Duke University, Durham, North Carolina, United States., Huang DQ; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, National University Health System, Singapore., Yeh ML; Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital; Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan., Trinh L; Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, United States., Tsai PC; Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital; Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan., Hsu YC; Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Cancer Hospital/I-Shou University, Kaohsiung, Taiwan., Kam LY; Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, United States., Nguyen VH; Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, United States., Ogawa E; Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan., Lee DH; Division of Gastroenterology, Department of Internal Medicine, Good Gang-An Hospital, Busan, South Korea., Ito T; Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Japan., Watanabe T; Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki, Japan., Enomoto M; Department of Hepatology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan., Preda CM; Department of Gastroenterology and Hepatology, Clinic Fundeni Institute, Romania., Ko MKL; Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China., Wan-Hin Hui R; Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China., Atsukawa M; Division of Gastroenterology and Hepatology, Nippon Medical School, Tokyo, Japan., Suzuki T; Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan., Marciano S; Liver Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina., Barreira A; Liver Unit, Department of Internal Medicine, Hospital Universitari Valle d'Hebron and Universitat Autònoma de Barcelona, and CIBEREHD del Instituto Carlos III. Barcelona, Spain., Do S; Digestive Health Associates of Texas, United States., Uojima H; Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan., Takahashi H; Liver Center, Saga University Hospital, Saga, Japan., Quek SXZ; Division of Gastroenterology and Hepatology, National University Health System, Singapore., Toe Wai Khine HH; Division of Gastroenterology and Hepatology, National University Health System, Singapore., Ishigami M; Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Japan., Itokawa N; Division of Gastroenterology and Hepatology, Nippon Medical School, Tokyo, Japan., Go MS; Division of Gastroenterology, Department of Internal Medicine, Good Gang-An Hospital, Busan, South Korea., Kozuka R; Department of Hepatology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan., Marin RI; Department of Gastroenterology and Hepatology, Clinic Fundeni Institute, Romania., Sandra I; Department of Gastroenterology and Hepatology, Clinic Fundeni Institute, Romania., Li J; Wong Clinics, San Francisco, California, United States., Zhang JQ; Chinese Hospital, San Francisco, California, United States., Wong C; Wong Clinics, San Francisco, California, United States., Yoshimaru Y; Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan., Vo DKH; Digestive Health Associates of Texas, United States., Tseng CH; Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Cancer Hospital/I-Shou University, Kaohsiung, Taiwan., Lee CJ; Division of Gastroenterology, Department of Internal Medicine, Good Gang-An Hospital, Busan, South Korea., Inoue K; Liver Center, Saga University Hospital, Saga, Japan., Maeda M; Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, United States., Hoang JK; Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, United States., Chau A; Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, United States., Chuang WL; Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital; Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan., Dai CY; Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital; Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan., Huang JF; Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital; Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan., Huang CF; Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital; Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan., Buti M; Liver Unit, Department of Internal Medicine, Hospital Universitari Valle d'Hebron and Universitat Autònoma de Barcelona, and CIBEREHD del Instituto Carlos III. Barcelona, Spain., Tanaka Y; Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan; Department of Clinical Laboratory Medicine, Nagoya City University Hospital, Nagoya, Japan; Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan., Gadano AC; Liver Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina., Yuen MF; Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China., Cheung R; Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, United States; Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, United States., Lim SG; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, National University Health System, Singapore., Trinh HN; San Jose Gastroenterology, San Jose, California, United States., Toyoda H; Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan., Yu ML; Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital; Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan., Nguyen MH; Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, United States; Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, California, United States. Electronic address: mindiehn@stanford.edu.
Jazyk: angličtina
Zdroj: Journal of hepatology [J Hepatol] 2024 Jul; Vol. 81 (1), pp. 33-41. Date of Electronic Publication: 2024 May 01.
DOI: 10.1016/j.jhep.2024.02.033
Abstrakt: Background & Aims: Oral antiviral therapy with nucleos(t)ide analogues (NAs) for chronic hepatitis B (CHB) is well-tolerated and lifesaving, but real-world data on utilization are limited. We examined rates of evaluation and treatment in patients from the REAL-B consortium.
Methods: This was a cross-sectional study nested within our retrospective multinational clinical consortium (2000-2021). We determined the proportions of patients receiving adequate evaluation, meeting AASLD treatment criteria, and initiating treatment at any time during the study period. We also identified factors associated with receiving adequate evaluation and treatment using multivariable logistic regression analyses.
Results: We analyzed 12,566 adult treatment-naïve patients with CHB from 25 centers in 9 countries (mean age 47.1 years, 41.7% female, 96.1% Asian, 49.6% Western region, 8.7% cirrhosis). Overall, 73.3% (9,206 patients) received adequate evaluation. Among the adequately evaluated, 32.6% (3,001 patients) were treatment eligible by AASLD criteria, 83.3% (2,500 patients) of whom were initiated on NAs, with consistent findings in analyses using EASL criteria. On multivariable logistic regression adjusting for age, sex, cirrhosis, and ethnicity plus region, female sex was associated with adequate evaluation (adjusted odds ratio [aOR] 1.13, p = 0.004), but female treatment-eligible patients were about 50% less likely to initiate NAs (aOR 0.54, p <0.001). Additionally, the lowest evaluation and treatment rates were among Asian patients from the West, but no difference was observed between non-Asian patients and Asian patients from the East. Asian patients from the West (vs. East) were about 40-50% less likely to undergo adequate evaluation (aOR 0.60) and initiate NAs (aOR 0.54) (both p <0.001).
Conclusions: Evaluation and treatment rates were suboptimal for patients with CHB in both the East and West, with significant sex and ethnic disparities. Improved linkage to care with linguistically competent and culturally sensitive approaches is needed.
Impact and Implications: Significant sex and ethnic disparities exist in hepatitis B evaluation and treatment, with female treatment-eligible patients about 50% less likely to receive antiviral treatment and Asian patients from Western regions also about 50% less likely to receive adequate evaluation or treatment compared to Asians from the East (there was no significant difference between Asian patients from the East and non-Asian patients). Improved linkage to care with linguistically competent and culturally sensitive approaches is needed.
(Copyright © 2024 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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