Liu et al. Clinical and Translational Gastroenterology (2018) 9:141
Clinical and Translational Gastroenterology
ORIGINAL CONTRIBUTION Open Access
Increasing co-morbidities in chronic
hepatitis B patients: experience in primary
care and referral practices during
Anne Liu, MD
, Chris Wong, MD
, Clifford Wong, MD
, Linda Henry, PhD
Mindie H. Nguyen, MD, MAS
Objectives: Data on liver and non-liver co-morbidities in chronic hepatitis B (CHB) patients are limited. This study
analyzes the prevalence of co-morbidities in a multicenter CHB cohort evaluated over 15 years.
Methods: This study included 2734 consecutive adult American CHB patients from a university medical center and
several community primary care clinics. Data were analyzed by time periods (patients in each time period were
unique without overlapping): 2000–2005 (n = 885), 2006–2010 (n = 888), and 2011–2015 (n = 961). Patients were
identiﬁed via electronic query using diagnosis code with data conﬁrmed and extracted via individual chart review.
Most patients were male (57.9%) and Asian (89.6%).
Results: Mean age increased signiﬁcantly from 43.3 ± 13.4 years during 2000–2005 to 49.1 ± 14.4 during 2011–2015
(p < 0.001). Between 2000–2005 and 2011–2015, fatty liver disease among new CHB patients increased from 1.6 to
6.8% (p < 0.001). Advanced liver diseases also increased (p < 0.001): cirrhosis (12.6–24.6%), hepatic decompensation
(1.1–7.9%), and hepatocellular carcinoma (HCC) (4.9–9.1%). Similar trends were observed for non-liver co-morbidities
(p < 0.001). Speciﬁcally, diabetes increased almost ﬁvefold (4.9–22.9%), hypertension increased threefold
(12.3–36.1%) and chronic kidney disease increased 4.5-fold (4.4–19.7%). Prevalence of osteopenia and osteoporosis
also increased in CHB patients: 5.4–13.4% (p < 0.001) and 2.9–8.7% (p < 0.001), respectively. These trends were
observed in both liver clinics and primary care clinics (except for advanced liver disease), treated and untreated
patients, and for both sexes.
Conclusions: The CHB patient population is aging and now presents with signiﬁcantly more co-morbidities. Early
diagnosis and linkage to care is needed to prevent and mitigate liver as well as non-liver co-morbidities.
There are 1.25 million individuals in North America
and 248 million individuals globally
who have chronic
hepatitis B (CHB)
. The estimated number of patients
with CHB-related cirrhosis, hepatic decompensation, and
deaths was 341,400 in 2005 and 371,100 in 2015
© The Author(s) 2018
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Correspondence: Mindie H. Nguyen (firstname.lastname@example.org)
Yale New Haven Health, New Haven, CT, USA
Stanford University School of Medicine, Stanford, CA, USA
Full list of author information is available at the end of the article
These authors contributed equally: Anne Liu, An Le.
Ofﬁcial journal of the American College of Gastroenterology