D0515 - Treatment and Hepatocellular Carcinoma Screening Patterns Among Black Patients With Chronic Hepatitis B

Tuesday, October 25, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Sanjana Rao, MD

University of Miami, Miller School of Medicine
Miami, FL

Sanjana Rao, MD¹, Pranusha Atuluru, BS², Leo S. Kleyman, BS³, Gaddipati Sirisha, MD², Malika Elmengad, ¹, Patricia Jones, MD, MSCR³
¹University of Miami, Miller School of Medicine, Miami, FL; ²University of Miami, Miami, FL; ³University of Miami Miller School of Medicine, Miami, FL

Introduction: Significant racial disparities exist in Hepatitis B virus (HBV) infection across the nation, from screening variability to treatment patterns and clinical outcomes. The Black community bears a disproportionately large disease burden. In this study, we sought to compare the disease courses between Black patients seen at a private tertiary referral center vs. those evaluated at a high-volume county safety net hospital.

Methods: Using informatics, we identified adult patients with chronic HBV based on ICD-10 codes, who had ≥1 clinic visit between January 1, 2010 and December 31, 2020 at University of Miami Hospital (UM) and Jackson Memorial Hospital (JM). We conducted retrospective chart review to gather demographic and clinical data. We used descriptive statistics, Kruskal-Wallis, and Pearson’s chi squared tests to evaluate for differences between Black patients at each hospital with the significance interval set to p < 0.05. Analyses were conducted using STATA 17.0.

Results: Of 649 Black patients detected by informatics, 364 had confirmed HBV with 306 seen at UM and 58 at JM. Compared to JM, UM patients were significantly older, English speakers, and privately insured (p < 0.001) (Table 1). Most common birth countries included Haiti and the USA, among others (Figure 1). 78.8% of UM patients were evaluated by Hepatology, compared to 41.1% at JM. More JM patients had active hepatitis, and 15.5% had a high viral load (HBV DNA PCR >20,000) compared to 3.3% at UM. Patients seen at UM were more likely to be treated, 52.9%, vs. 24.6% at JM and placed on newer regimens (ie Tenofovir [TAF] and Entecavir). UM patients were significantly more likely to undergo HbeAg and HbeAb testing, compared to their JM counterparts. Black patients at JM were significantly more likely to have alcoholic liver disease, ascites, and orthotopic liver transplantation. Although more UM patients underwent surveillance for hepatocellular carcinoma (HCC), there was ultimately no significant difference in patients being diagnosed with HCC between hospitals.

Discussion: These findings suggest that significant differences in demographics, referral patterns, laboratory evaluation, and management exist between Black patients at UM vs. JM, despite both hospitals being affiliated with the same academic institution. Our analysis on JM patients is ongoing and will be crucial to inform future interventions aimed at standardizing and providing evidence-based HBV care across medical centers.

Figure: Figure 1. Geographic distribution of Black patients’ most common birth countries. Green UM, Orange JM.

Variable	Blacks @ JM (n = 58)		Blacks @ UM (n = 306)	p-value
Median Age, years (IQR)	54 (45-63)	59 (47-66)		0.0001
Male Gender, %	68.3	63.7		0.24
US Born, %	50.9	32.7		0.012
Department seen by, % Hepatology	41.4	78.8		< 0.001
General Internal Med Gastroenterology	62.1 1.7	8.8 14.1		< 0.001 0.008
HbeAg / HbeAb checked, %	52.6	78.5		< 0.001
Active hepatitis, %	19	2.9		< 0.001
High viral load ( >20,000), %	15.5	3.3		< 0.001
Currently on Treatment, %	24.6	52.9		< 0.001
Tenofovir TDF TAF Entecavir Adefovir Lamivudine	13.8 13.7 13.1 13.4 0.6 8.6	31.4 12.1 1.7 5.2 0 1.6		0.007 0.74 0.0014 0.078 0.54 0.003
Alcoholic Liver Disease, %	14	1.8		< 0.001
Ascites, %	22.8	7.3		< 0.001
OLT, %	26.3	1.8		< 0.001
HCC Screening, % Fibroscan AFP Surveillance imaging (< 6 months)	17.5 42.11 58.9	31 78.3 77.9		0.04 < 0.001 0.003
Diagnosed with HCC	5.1	5.9		0.71

Table: Table 1. Comparison of demographics, screening, and management patterns between Black patients at JM vs. those at UM. AFP = alpha-fetoprotein; OLT = orthotopic liver transplantation; HCC = hepatocellular carcinoma.

Disclosures:

Sanjana Rao indicated no relevant financial relationships.

Pranusha Atuluru indicated no relevant financial relationships.

Leo Kleyman indicated no relevant financial relationships.

Gaddipati Sirisha indicated no relevant financial relationships.

Malika Elmengad indicated no relevant financial relationships.

Patricia Jones indicated no relevant financial relationships.

Sanjana Rao, MD¹, Pranusha Atuluru, BS², Leo S. Kleyman, BS³, Gaddipati Sirisha, MD², Malika Elmengad, ¹, Patricia Jones, MD, MSCR³. D0515 - Treatment and Hepatocellular Carcinoma Screening Patterns Among Black Patients With Chronic Hepatitis B, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.