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. 2020 Jul;52(2):382-389.
doi: 10.1111/apt.15803. Epub 2020 May 20.

Mortality in adults with chronic hepatitis B infection in the United States: a population-based study

Kali Zhou  1   2 , Jennifer L Dodge  1 , Joshua Grab  2 , Eduard Poltavskiy  2   3 , Norah A Terrault  1
Affiliations

Mortality in adults with chronic hepatitis B infection in the United States: a population-based study

Kali Zhou et al. Aliment Pharmacol Ther. 2020 Jul.

Abstract

Background: Chronic hepatitis B infection is an important contributor to mortality in the United States, yet impact of available and effective oral antivirals on mortality among infected individuals is unknown.

Aims: To compare risks and predictors of mortality in a recent time period between those with chronic, prior and no hepatitis B infection.

Methods: This is a population-based cohort study of National Health and Nutrition Examination Surveys participants between 1999 and 2014 linked to National Death Index data. Adults aged 20 years or older with hepatitis B serologic testing were included. Outcomes of all-cause and liver-related mortality were evaluated using Cox regression.

Results: Of 39 206 participants, 192 (0.5%) had chronic and 2694 (6.9%) had prior hepatitis B infection. The all-cause age/sex-standardised mortality rates for chronic, prior and uninfected were 21.4, 15.1 and 11.8 per 1000 person-years respectively. Liver-related mortality occurred at respective rates of 4.1, 0.3 and 0.1 per 1000 person-years. In multivariable analyses, those with chronic infection had 1.9-fold (95% CI 1.1-3.3) increased hazard of all-cause mortality and 13.3-fold (95% CI 3.9-45.5) increased hazard of liver-related mortality compared to uninfected. Predictors of all-cause mortality among chronic infection included heavy alcohol use (HR 18.3, 95% CI 3.3-100.6) and higher alanine aminotransferase (HR 1.02, 95% CI 1.00-1.03).

Conclusions: Mortality among adults living with chronic hepatitis B infection still exceeds that of uninfected despite availability of improved therapeutics. Identification of chronic infection, initiation of treatment among eligible and modulation of co-factors for disease progression are needed to improve survival.

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Conflict of interest statement

Statement of Interests

Authors’ declaration of personal interests

Dr. Terrault reports institutional grant support from Gilead Sciences. The other authors disclose no conflicts.

Figures

Figure 1.
Figure 1.
NHANES Cohort Selection Abbr: HBV=hepatitis B virus; anti-HBc=hepatitis B core antibody; HBsAg=hepatitis B surface antigen “Chronic” infection defined as anti-HBc+/HBsAg+; “Prior” infection defined as anti-HBc+/HBsAg-; “Never” infection defined as anti-HBc-/HBsAg-
Figure 2.
Figure 2.
Trend in All-Cause Mortality Rates by Chronic Hepatitis B Status in 4-year Intervals (1999–2014) All-cause age- and sex-standardized mortality rates for chronic infection (solid), prior infection (solid/dot) and no infection (dotted) presented per 1000 person-years by 4-year intervals between 1999 and 2014. P-value given for linear trend.
See this image and copyright information in PMC

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