Background and aims

Hepatitis delta virus (HDV) infection leads to the most severe form of viral hepatitis and is always associated with hepatitis B virus (HBV) infection. This study estimates the prevalence and describes patient characteristics for HDV-infected adults in the US using real-world insurance claims data.


Adults (≥18 years) with ≥1 inpatient claim or ≥2 outpatient claims (ICD-9/10-CM diagnosis codes) ≥30 days apart for HDV infection or HBV monoinfection in the All-Payer Claims Database from 1/1/2014 to 12/31/2020 (study period) were identified. Prevalence was the proportion of HDV-infected among HBV-infected patients. Patient characteristics were reported for a sub-cohort of patients with HDV. The HDV index date was defined as the first HDV diagnosis from 1/1/2015 to 12/31/2019 with ≥12 months pre- and post-diagnosis continuous enrolment. Patient characteristics included age, gender, race, geographic region, and payer type. Socioeconomic status data captured annual household income and education. Comorbidities were assessed over the 12-months pre-index (baseline) period.


Among 194, 573 adults with HBV, 9, 376 (4.8%) were coinfected with HDV. Among 6, 719 adults in the HDV sub-cohort, mean age was 51.9 ± 15.1 years, mean Charlson Comorbidity index score was 1.7 ± 2.3, 50.5% were female; 44.9% lived in the north-central and 23.7% in the northeast region of US. Among those with available data on race and socioeconomic status, the majority were white (48.8%), followed by black (36.6%) and Asian (13.7%); mean annual household income was $41, 515 (± $44, 697); 64.0% had high school as the highest education category. Patients most commonly had commercial insurance (42.7%), followed by Medicaid (34.2%), or Medicare (19.9%). At Baseline, 16.3% of patients had compensated cirrhosis, 10.4% had decompensated cirrhosis, 2.8% had liver cancer, and 2.2% had liver transplant. Diabetes (50.5%), hypertension (49.8%), HIV infection (30.9%), substance abuse (28.7%), and smoking history (28.1%) were the top five comorbidities.


Among a large database capturing approximately 80% of the US insured population, HDV infection prevalence was 4.8% among HBV-infected adults. HDV-infected patients had high rates of baseline comorbidities and liver complications. Earlier identification of HDV infection among HBV-infected patients may provide opportunities to reduce the risk of liver-related morbidity and mortality.

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