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    Original Investigation
    Gastroenterology and Hepatology
    April 9, 2020

    Diagnosis Rates of Chronic Hepatitis B in Privately Insured Patients in the United States

    Author Affiliations
    • 1Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, California
    • 2Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
    • 3Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
    JAMA Netw Open. 2020;3(4):e201844. doi:10.1001/jamanetworkopen.2020.1844
    Key Points español 中文 (chinese)

    Question  What is the actual rate of diagnosis for patients with chronic hepatitis B in the US?

    Findings  This cross-sectional study using data on more than 100 million patients from a large US nationwide claims database of patients with private insurance and the National Health and Nutrition Examination Survey found that only 18.60% of privately insured patients with chronic hepatitis B had been diagnosed.

    Meaning  This study found low rates of hepatitis B diagnosis among privately insured individuals, suggesting that barriers to diagnosis may be both financial and nonfinancial; additional research is needed to characterize these barriers and to develop interventions to improve diagnosis rates.


    Importance  To achieve the World Health Organization goal of viral hepatitis elimination by 2030, it is important to estimate current rates of chronic hepatitis B (CHB) diagnosis and treatment.

    Objective  To provide an accurate accounting of the number of patients with CHB aged 6 years or older who have not yet been diagnosed in the United States.

    Design, Setting, and Participants  This cross-sectional study used the commercial US Truven Health MarketScan Database (138 634 154 privately insured individuals in January 2007 to December 2014) to identify patients with CHB diagnosis and the National Health and Nutrition Examination Survey to estimate the actual number of privately insured persons with CHB. Based on sex and age distribution derived from the US Census Bureau, we calculated the total population with CHB and the proportion of those who remained undiagnosed among the 198 073 302 privately insured individuals. Next, we identified diagnosed CHB patients who received 1 or more prescription for CHB medications to calculate the treatment rate for those with severe disease states, such as cirrhosis and hepatocellular carcinoma, that would warrant treatment. Analyses were performed from October 2017 to January 2020.

    Main Outcomes and Measures  The rate and number of patients with CHB who remained undiagnosed and treatment rates for patients with CHB who have cirrhosis or hepatocellular carcinoma.

    Results  Among the 198 073 302 privately insured individuals (48.55% male; 15.52% aged 6-17 years; 84.48% aged ≥18 years), there were 511 029 (95% CI, 317 733-704 325) individuals with CHB, but only 95 075 of these had been diagnosed, yielding a diagnosis rate of only 18.60% (95% CI, 13.50%-29.92%), meaning that 81.40% (95% CI, 70.08%-86.50%) were undiagnosed. The treatment rates were 34.79% (95% CI, 33.31%-36.27%) for those with cirrhosis and 48.64% (95% CI, 45.59%-51.69%) for those with hepatocellular carcinoma.

    Conclusions and Relevance  In this study, only approximately 1 in 5 privately insured patients with CHB had been diagnosed. Only one-third of patients with CHB who had cirrhosis and one-half who had hepatocellular carcinoma received antiviral therapy. Further efforts are needed to improve the current situation of poor connection to care for patients with CHB, especially for those with advanced liver disease.