S1193 Differences in Prevalence and Treatment of Hepatitis B Virus Infection in Asian and Black Patients

Abstract

Introduction: Hepatitis B virus (HBV) infection, an important cause of chronic liver disease, has a prevalence of 4.3% in the United States (US) and causes significant morbidity and mortality. Immigrants and racial/ethnic minorities are disproportionately burdened by HBV. Few studies have investigated characteristics of HBV infection and treatment by race; therefore, we sought to understand and compare risk factors, barriers to care, and treatment patterns in Blacks and Asians, the two most disproportionately impacted groups. Methods: Using informatics, we identified patients with possible HBV based on ICD-10 code B18.1, who were seen between May 2010 and July 2021 at a tertiary referral center. We performed retrospective chart review to confirm infection and captured sociodemographic/clinical data. We used descriptive statistics, Kruskal-Wallis and Pearson’s chi squared tests to evaluate for differences between Black and Asian patients. Analyses were conducted using STATA 17.0(College Station, Texas). Results: Out of 673 patients, 509 had confirmed HBV: 308 Black and 201 Asian patients. Compared to Asians, Blacks were older and more likely to be male and US-born. Top birth countries included Haiti, 22%, US, 18%, China, 16%, and Vietnam, 8% (Fig 1a). Risk factors for HBV differed significantly; 44% of Asians had a family history of HBV compared to 8% of Blacks, p < 0.001 (Table). Clinical notes for Black patients were more likely to document history of injection drug use, blood transfusions and tattoos. The predominant HBV genotype was A in Blacks and B in Asians (Fig 1b). Despite no significant differences in prevalence of cirrhosis or infection phenotype, there were treatment differences; 60 % of Blacks vs. 70% of Asians were treated, p 0.04. More Black patients had concurrent HIV or HCV, 14% and 5%, respectively compared to 0-1% of HIV and HCV in Asians. NAFLD was more common in Asians, 27%, vs 12% in Blacks. While 97% of Blacks and 70% of Asians met Hepatocellular carcinoma (HCC) screening criteria, only 67% of Blacks and 44% of Asians of those meeting criteria were screened in the past twelve months. Conclusion: There are significant differences in risk factors, access to care and treatment between Black and Asian patients in our institution. Future studies should seek to understand barriers to treatment and the determinants of inadequate HCC screening in both Asian and Black patients, given the dire consequences of HBV-related HCC in these communities.Figure 1.: a) Birth Country Distribution of HBV Patients, b) Predominant HBV genotype of Black and Asian Patients Table 1. - Demographics and Clinical Characteristics of Black and Asian Patients with HBV Variable Black Asian p-value (n = 308) (n = 201) Median Age, years (IQR) 56.97 (46.21-65.1) 51.54 (42.63-61.86) 0.003 Male Gender, n (%) 199 (64.8) 103 (51.2) 0.002 Hispanic Ethnicity, n (%) 23 (8.1) 3 (1.5) 0.002 English-speakers, n (%) 266 (86.4) 182 (90.6) < 0.001 US-Born, n (%) 73 (32.9) 9 (5.1) < 0.001 Insurance Type, n (%) < 0.001 Private 185 (63.4) 148 (74.8) Medicaid/Medicare 93 (31.9) 33 (16.7) Uninsured 12 (4.1) 12 (6.1) Married (not separated), n (%) 146 (52.1) 143 (72.6) < 0.001 Risk Factors, n (%) Intravenous Drug Use 4 (1.4) 1 (0.5) < 0.001 Intranasal Cocaine 19 (6.6) 1 (0.5) < 0.001 Non-IV Drug Use 19 (6.6) 1 (0.5) < 0.001 Sexually Transmitted Diseases 34 (11.9) 5 (2.5) < 0.001 Transfusions 54 (19.2) 16 (8.1) < 0.001 Family history of hepatitis 11 (3.9) 6 (3.1) < 0.001 Family history of HBV 22 (7.6) 87 (44.4) < 0.001 Family history of HCC 12 (4.2) 37 (18.9) < 0.001 Tattoos 26 (9) 9 (4.6) < 0.001 Other Medical Conditions, n (%) Non-alcoholic Fatty Liver Disease (NAFLD) 32 (11.6) 53 (27.2) < 0.0001 Human Immunodeficiency Virus (HIV) 39 (13.8) 0 (0) < 0.001 Hepatitis C Virus (HCV) 13 (4.5) 2 (1) < 0.001 Ever Treated for HBV, n (%) 166 (60.4) 136 (69.7) 0.037 Currently Treated for HBV, n (%) 148 (52.5) 105 (55) 0.59 Phenotype, n (%) 0.195 Immune tolerant 2 (0.8) 1 (0.5) HbeAg positive active ( > 20000 DNA) 7 (2.7) 2 (1) HbeAg negative active ( > 2000 DNA) 9 (3.5) 6 (3.1) Inactive carrier 175 (67.6) 117 (60.3) Indeterminate 66 (25.5) 68 (35.1) Met criteria for HCC Screening, n (%) 299 (97.1) 141 (70.2) < 0.0001 HCC Screening < 6 months before visit, n (%) 219 (76.6) 91 (46.7) < 0.001 HCC Screening < 12 months before visit, n (%) 190 (66.7) 86 (44.1) < 0.001 Demographics and Clinical Characteristics of Black and Asian Patients with HBVp value of <0.05 is considered significant).