Most Chronic Hepatitis B Diagnoses in US Are Late

Medscape

13-06-2025

More than 75% of chronic hepatitis B diagnoses in the United States occur late — within 2 years before or after the onset of a liver complication — highlighting the need for improved screening to prevent poor outcomes.
METHODOLOGY:
Late diagnosis of chronic hepatitis B represents a missed opportunity to intervene early and prevent liver-related complications.
Researchers conducted a retrospective analysis of the Truven MarketScan database (2007 to 2021) to estimate the prevalence of late diagnosis of chronic hepatitis B in the US and associated liver complications.
Eligible patients had chronic hepatitis B diagnosis and at least 12 months of insurance coverage prior to the first liver complication (cirrhosis, hepatocellular carcinoma [HCC], or liver transplant).
A diagnosis was defined as late if it occurred within 2 years before or after the first liver complication, and non-late if was made more than 2 years before the complication.
TAKEAWAY:
Of 2608 patients included (mean age, 54.83 years; 29.7% women), 76.6% had a late diagnosis of chronic hepatitis B; among these, 44.5% were diagnosed at or within 6 months of their first liver complication, and 75.5% lacked a documented visit to a medical provider prior to their first liver complication.
Among those diagnosed > 36 months after the first liver complication, 46% already had another liver disease.
Despite treatment advances, the rate of late diagnosis remained stable between 2010 (78.8%) and 2019 (89.3%; P for trend = . 438).
for trend 438). Among patients with a late diagnosis, 91.0% had cirrhosis, 81.5% had decompensated cirrhosis, 30.8% developed HCC, and 14.4% underwent liver transplant.
Independent predictors of late diagnosis included male sex, alcohol use, and having Preferred Provider Organization (PPO) or Health Maintenance Organization/PPO hybrid insurance.
IN PRACTICE:
'Our study suggests that the majority of [hepatitis B virus] diagnoses in the United States are likely incidental from the work-up of a liver complication. These patients can be seen as 'missed opportunities' for treatment and intervention to prevent disease progression and adverse hepatic outcomes,' the authors wrote.
SOURCE:
This study was led by Michael Le and Joanne K. Liu, Stanford University Medical Center, Stanford, California. It was published online in Alimentary Pharmacology & Therapeutics .
LIMITATIONS:
This study excluded uninsured individuals and those covered by government insurance (eg, Medicaid), potentially underrepresenting higher-risk populations. Reliance on claims data may have affected the accuracy of diagnosis rates. Data on race, ethnicity, and foreign-born status were unavailable, preventing analysis of these important factors.
DISCLOSURES:
The authors received no specific funding for this work. No conflicts of interest were disclosed by the authors.