BACKGROUND: Hepatitis delta is caused by a defective RNA virus (HDV) that requires the presence of hepatitis B surface antigen for replication and transmission. Compared to hepatitis B virus (HBV) monoinfection, patients with HDV have a greater risk of cirrhosis, hepatocellular carcinoma, liver transplant, and liver-related mortality. This retrospective cohort study compared clinical and patient characteristics of adults with HDV vs HBV in the US.

METHODS: Commercially insured adults (≥18 years) with ≥1 inpatient claim or ≥2 outpatient claims ≥30 days apart for HDV or HBV based on ICD-9/10-CM diagnosis codes were identified from 1/1/2015 to 12/31/2019 in the All-payer Claims Database. The date of first diagnosis within the identification period was the index date; patients were required to have ≥12 months of continuous enrolment before and after index date. Baseline characteristics were assessed prior to index date. Descriptive statistics were summarized, and comparisons were made via chi-square tests. 

RESULTS: Among 2,871 adults with HDV and 73,729 with HBV, mean age was similar (47.5 ± 12.1 years in HDV vs 48.0 ± 11.4 years in HBV), and patients were mostly male (53.0% vs 53.3%). Among those with data available, HDV patients were more likely to be Black (33.6% vs 16.9%, p<0.0001) and less likely to be Asian (18.0% vs 37.7%, p<0.0001). HDV patients had significantly lower mean annual household income ($44,756 vs $54,493, p<0.0001) and education level (proportion with high school as the highest education category: 65.7% in HDV vs 54.4% in HBV, p<0.0001). A higher proportion of HDV patients resided in the north-central US region (33% vs 11%, p<0.0001). Mean Charlson Comorbidity Index was higher among HDV vs HBV (1.6 vs 0.9, p<0.0001). HDV patients also had significantly greater prevalence of comorbidities at index, such as hypertension (41.9% vs 30.4%, p<0.0001), diabetes (39.6% vs 20.9%, p<0.0001), history of smoking (25.9% vs 17.8%, p<0.0001), substance abuse (25.9% vs 11.5%, p<0.0001), and obesity (15.0% vs 10.3%, p<0.0001). HDV patients were more likely to have concurrent HIV infection (24.9% vs 7.6%, p<0.0001) or HCV infection (9.8% vs 7.0%, p<0.0001) and had significantly higher prevalence of compensated cirrhosis (16.9% vs 13.4%, p<0.0001), decompensated cirrhosis (10.1% vs 5.4%, p<0.0001), hepatocellular carcinoma (2.8% vs 1.3%, p<0.0001), and liver transplant (1.9% vs 0.6%, p<0.0001).

CONCLUSIONS: Among a large national cohort of commercially insured adults in the US, HDV patients had greater comorbidities and significantly higher liver disease severity than HBV patients at the index date. These findings underscore the need for early screening and diagnosis and eventual treatment of HDV to mitigate future disease progression.

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