Authors: Gish R, Jacobson I, Lim J, Kaushik A, Kachru N, Liu Y, Cyhaniuk A, Wong R.


Hepatitis Delta virus (HDV) leads to the most severe form of viral hepatitis and occurs inpatients with hepatitis B virus (HBV) infection. Limited real-world data exist regarding the epidemiology, demographic and clinical characteristics of HDV patients. This study estimates the prevalence and describes baseline characteristics for HDV patients among adults diagnosed with HBV in the United States.


Adult patients (≥18 years) with ≥1 claim based on ICD-9/10-CM diagnosis codes for HBV or HDV were identified in the US All-Payer Claims Database from 01/01/2014 to 12/31/2020 (study period). Prevalence was measured as the proportion of HDV patients among HBV. Among HDV patients, a sub-cohort was identified with the first HDV diagnosis defined as index date from 01/01/2015 to 12/31/2019 (identification period) and having >12 months of continuous capture prior to the index date. Baseline characteristics included age, gender, geographical region, payor type, Charlson Comorbidity Index (CCI) score and comorbidities. While comorbidities were assessed during the complete time period available prior to the index date, other characteristics were measured at the index date.


Among 291,961 adults with HBV during the study period, 32,730 had HDV diagnosis, resulting in an overall prevalence of 11.2%. Of these, baseline characteristics were assessed for 23,456 HDV patients who met the inclusion criteria of >12 months of continuous capture before index date. HDV patients had a mean (SD) age of 51.5 (±15.9) years with a CCI score of 1.5 (±2.26), 52.7% were female, 35.3% resided in the north-central and 30.5% in the northeast US geographical regions. Commercial insurance was the most frequent coverage (48.6%), followed by Medicare (23.1%) and Medicaid (22.9%). Hypertension (50.9%), history of smoking (26.4%), HIV (24.0%), and substance abuse (17.2%) were the top comorbidities. In addition, rate of compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, and liver transplant were 13.8%, 9.2%, 2.4%, and 1.3%, respectively.


Among a large population-based database that captures 80% of the US population, HDV prevalence of 11.2% was observed among diagnosed HBV adults. A high rate of comorbidities and liver complications was reported in the baseline period prior to HDV diagnosis. Earlier screening and identification of HDV infection among HBV patients may allow opportunities to reduce risk of liver-related morbidity and mortality.

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