新南威尔士州乙型肝炎通报人群中失代偿期肝硬化和肝细胞

StephenW

新南威尔士州乙型肝炎通报人群中失代偿期肝硬化和肝细胞癌的趋势
Syed Hassan Bin Usman Shah 1，Maryam Alavi 1，Behzad Hajarizadeh 1，Gail V Matthews 1 2，Marianne Martinello 1，Mark Danta 2，Janaki Amin 3，Matthew G Law 1，Jacob George 4，Heather Valerio 1，Gregory J Dore 1
隶属关系
隶属关系

    1 澳大利亚新南威尔士州悉尼新南威尔士大学 (UNSW) 柯比研究所。
    2 澳大利亚悉尼圣文森特医院。
    3 澳大利亚新南威尔士州悉尼麦考瑞大学卫生系统和人口系。
    4 Storr Liver Centre，Westmead Millennium Institute，悉尼大学和 Westmead 医院，Westmead，澳大利亚。

    PMID：36119722 PMCID：PMC9478454 DOI：10.1016/j.jhepr.2022.100552

抽象的

背景和目的：与 HBV 相关的失代偿期肝硬化 (DC)、肝细胞癌 (HCC) 和肝脏相关死亡率相关的人群水平趋势和因素对于评估治疗干预的影响至关重要。

方法：通过将 HBV 通知 (1993-2017) 与住院 (2001-2018)、死亡率 (1993-2018) 联系起来，确定澳大利亚新南威尔士州 HBV-DC 和 -HCC 诊断和肝脏相关死亡率的趋势, 和癌症登记 (1994-2014) 数据库。迟发 HBV 通知被定义为在 DC 或 HCC 诊断时或 2 年内通知。进行 Cox 比例风险回归和多变量逻辑回归分析以评估相关因素。

结果：在收到 HBV 通报的 60,660 人中，记录了 1,276 (2.0%) 例 DC 和 1,087 (1.8%) 例 HCC 诊断，以及 1,219 (2.0%) 例肝脏相关死亡。自 2000 年代初以来，DC 和 HCC 的诊断数量有所增加；然而，年龄标准化发病率分别从 2003 年的 2.64 和 1.95 下降到 2017 年的每千人年 1.14 和 1.09。同样，年龄标准化的肝脏死亡率从 2003 年的 2.60 人降至 2017 年的每千人年 1.14 人。在诊断为 DC 和 HCC 的人群中，晚期 HBV 通知从 2001-2009 年的 41% 和 40% 下降到 29% 和 25%分别在 2010-2018 年。 DC 诊断的预测因素包括年龄较大（出生 <1944 年，调整后的风险比 [aHR] 2.06，95% CI 1.57-2.69）、酒精使用障碍（aHR 4.82，95% CI 3.96-5.87）和 HCV 合并感染（aHR 1.88 , 95% CI 1.53-2.31)。 HCC 诊断的预测因素包括年龄较大（出生 <1944 年，aHR 3.94，95% CI 2.91-5.32）和男性（aHR 3.79，95% CI 3.05-4.71）。

结论：在抗病毒治疗改进的时代，HBV 相关肝脏发病率和死亡率的风险已经下降。 HCV 合并感染和酒精使用障碍是与 HBV 负担相关的关键可改变风险因素。

总结：乙型肝炎相关发病率和死亡率上升是一个主要的公共卫生问题。然而，针对乙型肝炎病毒 (HBV) 的高效药物的开发为到 2030 年消除乙型肝炎病毒带来了新的乐观情绪。这项研究表明，澳大利亚新南威尔士州与 HBV 相关的肝脏发病率和死亡率稳步下降。此外，迟发性肝炎通知也有所下降，使 HBV 感染者能够获得及时的抗病毒治疗。尽管如此，丙型肝炎合并感染和酒精使用障碍是与 HBV 疾病负担相关的关键可改变风险因素。为了从高效抗病毒治疗中获得预期的益处，管理合并症，包括丙型肝炎和大量饮酒，必须在乙型肝炎患者中得到改善。

关键词：APDC，入院患者数据收集；澳元，酒精使用障碍； CCI，查尔森合并症指数；直流; DC，失代偿期肝硬化； ESLD，终末期肝病；肝癌； HCC，肝细胞癌； LHD，当地卫生区； NCIMS，通知条件信息管理系统； NHR，国家艾滋病毒登记处；新南威尔士州，新南威尔士州； NSWCR，新南威尔士州癌症登记处； PBS，药品福利计划； RBDM，出生、死亡和婚姻登记处；世界卫生组织，世界卫生组织；死亡原因;乙型肝炎；迟到的 HBV 通知；肝病;肝脏死亡率；人口水平；记录联动；风险因素。

© 2022 作者。
利益冲突声明

ML 获得了默克、百时美施贵宝、勃林格殷格翰、Janssen-Cilag、Gilead Sciences 和 ViiV HealthCare 的研究支持。 ML 已收到 Gilead Sciences 的咨询和研讨会费用。 ML 已收到 Sirtex Pty Ltd 的数据安全监测委员会委员会费用。JG 是吉利德科学、默克、杨森、罗氏和 Pharmaxis 的发言人局成员。 JG 是吉利德科学、默克、杨森、百时美施贵宝、艾伯维、罗氏、葛兰素史克、Pharmaxis 和辉瑞的顾问委员会成员。 JG 获得了吉利德科学、默克、百时美施贵宝、艾伯维和罗氏的旅行支持。 GD 获得了吉利德科学、默克和艾伯维的研究支持。其他作者没有可能与本手稿产生利益冲突的商业关系。 通用汽车已获得吉利德科学和艾伯维的研究支持。 请参阅随附的 ICMJE 披露表格了解更多详情。

StephenW

Trends in decompensated cirrhosis and hepatocellular carcinoma among people with a hepatitis B notification in New South Wales
Syed Hassan Bin Usman Shah  1 , Maryam Alavi  1 , Behzad Hajarizadeh  1 , Gail V Matthews  1   2 , Marianne Martinello  1 , Mark Danta  2 , Janaki Amin  3 , Matthew G Law  1 , Jacob George  4 , Heather Valerio  1 , Gregory J Dore  1
Affiliations
Affiliations

    1    The Kirby Institute, University of New South Wales (UNSW), Sydney, NSW, Australia.
    2    St Vincent's Hospital, Sydney, Australia.
    3    Department of Health Systems and Populations, Macquarie University, Sydney, NSW, Australia.
    4    Storr Liver Centre, Westmead Millennium Institute, University of Sydney and Westmead Hospital, Westmead, Australia.

    PMID: 36119722 PMCID: PMC9478454 DOI: 10.1016/j.jhepr.2022.100552

Abstract

Background & aims: Population-level trends and factors associated with HBV-related decompensated cirrhosis (DC), hepatocellular carcinoma (HCC), and liver-related mortality are crucial to evaluate the impacts of therapeutic interventions.

Methods: Trends in HBV-DC and -HCC diagnoses and liver-related mortality in New South Wales, Australia, were determined through linkage of HBV notifications (1993-2017) to hospital admissions (2001-2018), mortality (1993-2018), and cancer registry (1994-2014) databases. Late HBV notification was defined as notification at or within 2 years of a DC or HCC diagnosis. Cox proportional-hazards regression and multivariable logistic regression analyses were performed to evaluate associated factors.

Results: Among 60,660 people with a HBV notification, 1,276 (2.0%) DC and 1,087 (1.8%) HCC diagnoses, and 1,219 (2.0%) liver-related deaths were documented. Since the early 2000s, the number of DC and HCC diagnoses increased; however, age-standardised incidence decreased from 2.64 and 1.95 in 2003 to 1.14 and 1.09 per 1,000 person-years in 2017, respectively. Similarly, age-standardised liver mortality decreased from 2.60 in 2003 to 1.14 per 1,000 person-years in 2017. Among people with DC and HCC diagnoses, late HBV notification declined from 41% and 40% between 2001-2009 to 29% and 25% in 2010-2018, respectively. Predictors of DC diagnosis included older age (birth <1944, adjusted hazard ratio [aHR] 2.06, 95% CI 1.57-2.69), alcohol use disorder (aHR 4.82, 95% CI 3.96-5.87) and HCV co-infection (aHR 1.88, 95% CI 1.53-2.31). Predictors of HCC diagnosis included older age (birth <1944, aHR 3.94, 95% CI 2.91-5.32) and male sex (aHR 3.79, 95% CI 3.05-4.71).

Conclusion: In an era of improved antiviral therapies, the risk of HBV-related liver morbidity and mortality has declined. HCV co-infection and alcohol use disorder are key modifiable risk factors associated with the burden of HBV.

Lay summary: Rising hepatitis B-related morbidity and mortality is a major public health concern. However, the development of highly effective medicines against hepatitis B virus (HBV) has brought renewed optimism for its elimination by 2030. This study shows a steady decline in HBV-related liver morbidity and mortality in New South Wales, Australia. Moreover, late hepatitis notification has also declined, allowing individuals with HBV to have access to timely antiviral treatment. Despite this, hepatitis C co-infection and alcohol use disorder are key modifiable risk factors associated with HBV disease burden. To attain the desired benefits from highly effective antiviral treatment, managing comorbidities, including hepatitis C and high alcohol use, must improve among individuals with hepatitis B.

Keywords: APDC, Admitted Patient Data Collection; AUD, alcohol use disorder; CCI, Charlson comorbidity index; DC; DC, decompensated cirrhosis; ESLD, end-stage liver disease; HCC; HCC, hepatocellular carcinoma; LHD, local health district; NCIMS, Notifiable Conditions Information Management System; NHR, National HIV Registry; NSW, New South Wales; NSWCR, NSW Cancer Registry; PBS, Pharmaceutical Benefits Scheme; RBDM, Registry of Births, Deaths and Marriages; WHO, World Health Organization; cause of death; hepatitis B; late HBV notification; liver disease; liver mortality; population-level; record linkage; risk factors.

© 2022 The Author(s).
Conflict of interest statement

ML has received research support from Merck, Bristol-Myers Squibb, Boehringer Ingelheim, Janssen-Cilag, Gilead Sciences, and ViiV HealthCare. ML has received consultancy and workshop fees from Gilead Sciences. ML has received Data Safety Monitoring Board Committee fees from Sirtex Pty Ltd. JG is on the speaker’s bureau for Gilead Sciences, Merck, Janssen, Roche, and Pharmaxis. JG is a member of advisory board for Gilead Sciences, Merck, Janssen, Bristol-Myers Squibb, AbbVie, Roche, GlaxoSmithKline, Pharmaxis and Pfizer. JG has received travel support from Gilead Sciences, Merck, Bristol-Myers Squibb, AbbVie, and Roche. GD has received research support from Gilead Sciences, Merck, and AbbVie. Other authors have no commercial relationships that might pose a conflict of interest in connection with this manuscript. GM has received research support from Gilead Sciences and AbbVie. Please refer to the accompanying ICMJE disclosure forms for further details.

StephenW

http://www.jhep-reports.eu/article/S2589555922001240/pdf