美国慢性乙型肝炎患者的年龄，性别，种族和抗病毒治疗状

StephenW

Trends in Cirrhosis and Mortality by Age, Sex, Race, and Antiviral Treatment Status Among US Chronic Hepatitis B Patients (2006-2016)
Mei Lu  1 , Jia Li, Yueren Zhou, Loralee B Rupp, Anne C Moorman, Philip R Spradling, Eyasu H Teshale, Joseph A Boscarino, Yihe G Daida, Mark A Schmidt, Sheri Trudeau, Stuart C Gordon, CHeCS Investigators
Affiliations
Affiliation

    1
    *Department of Public Health Sciences †Center for Health Policy and Health Services Research, Henry Ford Health System #Division of Gastroenterology and Hepatology, Henry Ford Health System and Wayne State University School of Medicine, Detroit, MI ‡Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA §Department of Epidemiology and Health Research, Geisinger Clinic, Danville, PA ∥Center for Health Research, Kaiser Permanente-Hawaii, Honolulu, HI ¶Center for Health Research, Kaiser Permanente-Northwest, Portland, OR.

    PMID: 33780209 DOI: 10.1097/MCG.0000000000001522

Abstract

Background: Changing US demographics and evolving chronic hepatitis B (CHB) treatments may affect longitudinal trends in CHB-related complications. We studied trends in the prevalence of cirrhosis (past or present) and incidence of all-cause mortality, stratified by patient age, sex, race, and antiviral treatment status, in a sample from US health care systems.

Methods: Joinpoint and Poisson regression (univariate and multivariable) were used to estimate the annual percent change in each outcome from 2006 to 2016.

Results: Among 5528 CHB patients, cirrhosis prevalence (including decompensated cirrhosis) rose from 6.7% in 2006 to 13.7% in 2016; overall mortality was unchanged. Overall rates of cirrhosis and mortality were higher among treated patients, but adjusted annual percent changes (aAPC) were significantly lower among treated than untreated patients (cirrhosis: aAPC +2.4% vs. +6.2%, mortality: aAPC -3.9% vs. +4.0%). Likewise, among treated patients, the aAPC for mortality declined -3.9% per year whereas among untreated patients, mortality increased +4.0% per year.

Conclusions: From 2006 to 2016, the prevalence of cirrhosis among CHB patients doubled. Notably, all-cause mortality increased among untreated patients but decreased among treated patients. These results suggest that antiviral treatment attenuates the progression of cirrhosis and the risk of death among patients with CHB.

StephenW

美国慢性乙型肝炎患者的年龄，性别，种族和抗病毒治疗状况的肝硬化和死亡率趋势（2006-2016年）
梅露1，贾莉，周月人，洛拉里·B·鲁普，安妮·C·摩尔曼，菲利普·R·斯普拉德林，Eyasu H Teshale，约瑟夫·博斯卡里诺，伊赫·G·戴达，马克·阿·施密特，谢里·特鲁多，斯图尔特·C·戈登，CHeCS调查员
隶属关系
联系

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    *公共卫生科学系†亨利·福特卫生系统卫生政策与卫生服务研究中心＃亨利·福特卫生系统胃肠病学和肝病科，密歇根州底特律亨利·福特大学医学院•国家中心病毒性肝炎科乔治亚州亚特兰大市疾病预防控制中心，艾滋病毒，肝炎，性病和结核病预防中心§宾夕法尼亚州丹维尔市盖辛格诊所流行病学和健康研究部俄勒冈州波特兰市Kaiser Permanente-西北卫生研究中心。

    PMID：33780209 DOI：10.1097 / MCG.0000000000001522

抽象的

背景：不断变化的美国人口统计数据和不断发展的慢性乙型肝炎（CHB）治疗可能会影响与CHB相关的并发症的纵向趋势。我们从美国卫生保健系统的样本中研究了肝硬化的流行趋势（过去或现在）和全因死亡率的发生率，并按患者年龄，性别，种族和抗病毒治疗状况进行了分层。

方法：使用Joinpoint和Poisson回归（单变量和多变量）来估计2006年至2016年每个结局的年度百分比变化。

结果：5528慢性乙型肝炎患者中，肝硬化患病率（包括代偿性肝硬化）从2006年的6.7％上升到2016年的13.7％；总体死亡率没有变化。总体肝硬化发生率和死亡率在接受治疗的患者中较高，但调整后的年变化百分比（aAPC）在接受治疗的患者中明显低于未接受治疗的患者（肝硬化：aAPC + 2.4％对+ 6.2％，死亡率：aAPC -3.9％对+ 4.0％）。同样，在接受治疗的患者中，死亡率的aAPC每年下降-3.9％，而在未经治疗的患者中，死亡率每年增加+ 4.0％。

结论：从2006年到2016年，CHB患者的肝硬化患病率增加了一倍。值得注意的是，全因死亡率在未治疗的患者中增加，但在治疗的患者中降低。这些结果表明，抗病毒治疗可减轻CHB患者的肝硬化进程和死亡风险。