Diagnosis of chronic hepatitis B peri‐complication: risk factors and trends over time

Background and Aims — Hepatitis B virus (HBV) is a major cause of chronic liver disease, which can progress to cirrhosis, hepatocellular carcinoma, and death. A timely diagnosis allows for antiviral treatment, which can prevent liver‐related complications. Conversely, a late diagnosis signals a missed opportunity for earlier care and treatment. Our objective was to measure the proportion of chronic HBV diagnoses that are made within 6 months of presentation with a liver disease‐related complication and examine associated factors and trends over time.

Approach and Results — We used provincial laboratory data to identify patients with chronic HBV diagnosed from 2003 to 2014. We measured the proportion who experienced a liver disease complication (decompensated cirrhosis, hepatocellular carcinoma, or liver transplant) within +/‐ 6 months of their HBV diagnosis date. A multivariable logistic regression model was used to identify factors associated with HBV diagnosis peri‐complication. Of 18,434 patients with chronic HBV, 1,279 (6.9%) developed an HBV‐related complication during the follow‐up period. Among these, 570 (44.6%) had a first diagnosis peri‐complication. HBV diagnosis peri‐complication did not decrease over time and was independently associated with older age at HBV diagnosis, rural residence, alcohol use, and moderate to high levels of comorbidity. Female patients, immigrants, and those with more outpatient physician visits were less likely to have an HBV diagnosis peri‐complication.

Conclusions — A high proportion of patients with HBV‐related complications are first diagnosed with HBV peri‐complication. These signal missed opportunities for earlier detection and treatment. Our findings support expansion of HBV screening.