Sex, ethnic disparities affect evaluation, treatment rates of CHB patients

Evaluation and treatment rates of patients with chronic hepatitis B (CHB) remain poor worldwide and differ by sex and race or ethnicity, reports a real-world study.

For instance, female patients are more likely to have adequate treatment evaluation but are less likely to receive nucleos(t)ide analogues (NAs) than males. Asian patients in the West are also less likely to undergo evaluation or to initiate NAs despite meeting the treatment criteria compared with their counterparts from the East.

“These data should serve as a call for action to improve awareness and linkage to care for people with CHB with culturally sensitive and linguistically competent approaches,” the researchers said.

A total of 12,566 treatment-naïve CHB patients (mean age 47.1 years, 41.7 percent female) from 25 centres in nine countries were included in this analysis. Of these, 96.1 percent were Asians and 49.6 percent were from the Western region. In addition, 8.7 percent had cirrhosis. [J Hepatol 2024;81:33-41]

Majority of the patients (73.3 percent) received adequate evaluation. Among those adequately evaluated, 32.6 percent were eligible for treatment based on the AASLD criteria, of whom 83.3 percent initiated NAs. Analyses using the EASL criteria found consistent findings.

Multivariate analysis adjusted for age, sex, cirrhosis, and ethnicity plus region revealed the association of female sex with adequate evaluation (adjusted odds ratio [aOR], 1.13; p=0.004). However, female patients who were eligible for treatment were less likely to initiate NAs (aOR, 0.54; p<0.001).

Furthermore, evaluation and treatment rates were lowest among Asian patients from the West, but no difference was noted between non-Asian and Asian patients from the East. Asian patients from the West were less likely to undergo adequate evaluation (aOR, 0.60) and initiate NAs (aOR, 0.54) than those from the East (p<0.001 for both).

Barriers

“[T]hese findings suggest there were potential language and cultural barriers to CHB care for Asian patients with CHB who reside in the West,” the researchers said. [World J Hepatol 2015;7:2955-2961]

A recent study reports that most patients with CHB in the US are foreign-born, most of whom are Asians. [Hepatology 2020;71:431-443]

“Thus, Asian patients residing in the West may avoid seeking care due to fear of social and institutional stigma, mistrust of Western medical systems, low health literacy in the host country’s language, and suboptimal communication with healthcare providers,” the researchers said. [Aliment Pharmacol Ther 2021;53:63-78]

Another notable finding from the current study was that one in 10 treatment-eligible patients with cirrhosis did not receive antiviral therapy despite being at the highest risk for developing hepatocellular carcinoma and liver failure. These are life-threatening conditions that can be prevented by antiviral treatment. [Clin Microbiol Rev 2020;33:e00046-19]

“These data call for increased awareness among patients, care providers, and healthcare policymakers regarding the routes of transmission, the importance of screening and prevention, evaluation, the availability of effective and well-tolerated treatments, as well as the cost-effectiveness of treatment,” the researchers said.

This cross-sectional study was nested within the retrospective multinational clinical consortium (2000‒2021). The researchers estimated the proportions of patients receiving adequate evaluation, meeting the AASLD treatment criteria, and initiating treatment at any time during the study period. They also determined which factors correlated with receiving proper evaluation and treatment using multivariable logistic regression analyses.