Increasing co-morbidities in chronic hepatitis B patients: experience in primary care and referral practices during 2000–2015

OBJECTIVES: Data on liver and non-liver co-morbidities in chronic hepatitis B (CHB) patients are limited. This study analyzes the prevalence of co-morbidities in a multicenter CHB cohort evaluated over 15 years. METHODS: This study included 2734 consecutive adult American CHB patients from a university medical center and several community primary care clinics. Data were analyzed by time periods (patients in each time period were unique without overlapping): 2000–2005 (n = 885), 2006–2010 (n = 888), and 2011–2015 (n = 961). Patients were identified via electronic query using diagnosis code with data confirmed and extracted via individual chart review. Most patients were male (57.9%) and Asian (89.6%). RESULTS: Mean age increased significantly from 43.3 ± 13.4 years during 2000–2005 to 49.1 ± 14.4 during 2011–2015 (p < 0.001). Between 2000–2005 and 2011–2015, fatty liver disease among new CHB patients increased from 1.6 to 6.8% (p < 0.001). Advanced liver diseases also increased (p < 0.001): cirrhosis (12.6–24.6%), hepatic decompensation (1.1–7.9%), and hepatocellular carcinoma (HCC) (4.9–9.1%). Similar trends were observed for non-liver co-morbidities (p < 0.001). Specifically, diabetes increased almost fivefold (4.9–22.9%), hypertension increased threefold (12.3–36.1%) and chronic kidney disease increased 4.5-fold (4.4–19.7%). Prevalence of osteopenia and osteoporosis also increased in CHB patients: 5.4–13.4% (p < 0.001) and 2.9–8.7% (p < 0.001), respectively. These trends were observed in both liver clinics and primary care clinics (except for advanced liver disease), treated and untreated patients, and for both sexes. CONCLUSIONS: The CHB patient population is aging and now presents with significantly more co-morbidities. Early diagnosis and linkage to care is needed to prevent and mitigate liver as well as non-liver co-morbidities.