Abstract

Authors: Jacobson I, Gish R, Lim J, Kaushik A, Kachru N, Sun X, Wong R.

Background

Hepatitis Delta (HDV/HBV) infection among Hepatitis B (HBV) patients is associated with significant morbidity and mortality. This study compares baseline characteristics of adult patients with HDV/HBV vs Hepatitis B monoinfection (HBV) in a national US claims database analysis.

Methods

The study population included adult patients (≥18 years) having ≥1 claim based on ICD-9/10-CM diagnosis codes for HDV/HBV or HBV in the All-Payer Claims Database from 01/01/2014 to12/31/2020 (study period). HDV/HBV coinfection and HBV cohorts were further identified from 01/01/2015 to 12/31/2019 (identification period) with their respective first diagnoses claim defined as the index date. All patients were required to have ≥12 months of continuous capture prior to the index date. Baseline characteristics including age, gender, payer type, Charlson Comorbidity Index (CCI) score and comorbidities were assessed prior to the index date. Descriptive statistics were summarized, and comparisons were made via chi-square tests.

Results

The final study population included 291,961 adults diagnosed with HDV/HBV or HBV of which224,844 met the inclusion criteria. Of these, 23,456 HDV/HBV (mean age 51.5±15.9 years) and 201,388HBV (mean age 53.5±14.7 years) patients were identified. Females comprised 52.7% of HDV/HBV patients in contrast to 47.3% of those with HBV. While both cohorts were largely covered by commercial insurance (48.6% vs 52.8%), HDV/HBV patients were more likely to be covered by Medicaid (22.8% vs 15.8%) and less likely by Medicare (23.1% vs 26.1%) vs HBV. CCI score was higher among HDV/HBV vs HBV patients (mean 1.5±2.26 vs 1.3±2.02, p<.0001). HDV/HBV patients had significantly higher comorbidities and liver complications including hypertension, history of smoking, substance abuse, alcohol abuse, mental health disorders, HCV infection, HIV infection, decompensated cirrhosis, hepatocellular carcinoma, and liver transplant than HBV monoinfected patients.

Conclusions

In a national payer database representing 80% of US claims, Hepatitis Delta patients were associated with significantly greater comorbidities and liver complications than Hepatitis B monoinfected patients. These findings underscore the need for early screening and diagnosis, and eventual treatment of Hepatitis Delta to mitigate future disease progression.

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