Does race affect treatment initiation and outcomes for chronic hepatitis B?

Chronic hepatitis B, or CHB, is a liver condition that affects nearly 2.4 million Americans.

“This condition disproportionately impacts individuals of Asian or African descent, who also experience significantly higher rates of liver cancer and at younger ages when compared to white Americans with the same condition,” said Anna Lok, M.D., assistant dean for clinical research, director of clinical hepatology at Michigan Medicine. “We wanted to find out whether racial disparities may play a part in this.”

Lok led a team of fellow experts to examine data from the Hepatitis B Research Network Adult Cohort Study, which was funded by the National Institute of Diabetes and Digestive and Kidney Diseases, or NIDDK, part of the NIH. The study included 20 study sites across the U.S. and one site in Canada. Their findings were recently published in JAMA Network Open.

“Our main goal was to determine if there were differences among racial groups when it comes to hepatitis B treatment initiation and outcomes,” said Lok, who is the senior author of this study. 

The research involved 1,550 participants and 193 of them identified as Black Americans, 1,157 identified as Asian Americans, 157 identified as white Americans, and 43 identified as “other races.” All participants had chronic hepatitis B but were not receiving antiviral treatment at the time of enrollment.

During the seven-year study, roughly 30% of the individuals started treatment through standard of care or one of two Hepatitis B Research Network clinical trials.

“A high percentage of Asian participants and Black participants were immigrants and differed from white participants across several social determinants of health, such as health insurance and education,” said Lok.

The team found that treatment initiation rates for chronic hepatitis B were lower among Black participants when compared to Asian and white participants in the overall group. However, the lower treatment rate among Black participants was “due to a lower percentage of individuals meeting guideline criteria for treatment, with a lower prevalence of hepatitis B ‘e antigen’ and lower levels of hepatitis B DNA,” according to Lok.

“When we focused on the participants who met treatment criteria, there were no significant differences in treatment initiation among racial groups.” 

Marc Ghany, M.D., M.H.Sc., chief of the clinical hepatology research section for the NIDDK Liver Diseases Branch and a study co-author, notes that this is one of the first studies that “examines whether the decision to start treatment for a patient with chronic hepatitis B is affected by race in the U.S.”

“The results are impactful because they suggest access to treatment may not be a major factor contributing to racial disparities in outcomes of chronic hepatitis B,” Ghany said.

The study’s first author, Mandana Khalili, M.D., professor of medicine at the University of California, San Francisco, chief of clinical hepatology and director of clinical and translational research in hepatology at San Francisco General Hospital, notes that the team “saw a gap between the number of patients eligible for treatment and those who actually received it, though the gap was similar across the racial groups.”

“We know about some of the patient, provider and system-related influences that may be causing this gap,” she said. “But more work is needed to understand exactly why.”

Lok says that their findings are “reassuring,” particularly since they found adverse clinical outcomes were very rare among this cohort and there were also no differences in outcomes among the racial groups. She cautioned that the study was conducted in academic liver centers, and racial disparities may exist in the real world where access to specialist care may not be equal.

Looking ahead, Khalili suggests taking the team’s research further.

“A potential next step is to look into community settings – those outside specialty care – to see if the gap between eligibility and treatment uptake for chronic hepatitis B is different among various patient groups, and to understand the factors that influence that. Addressing the gaps, whatever the setting, will involve increasing awareness about hepatitis B, the training of health care professionals and simplifying treatment guidelines.”

Research reported in this release was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under grant numbers: U01-DK082843, U01-DK082863, U01-DK082864, U01-DK082866, U01-DK082867,U01-DK082871,U01-DK082872, U01-DK082874, U01-DK082919, U01-DK082923, U01-DK082927, U01-DK082943, U01-DK082944, A-DK-3002-001, P30DK50306

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Paper cited: “Racial Disparities in Treatment Initiation and Outcomes of Chronic Hepatitis B Virus Infection in North America,” JAMA Network Open. DOI: 10.1001/jamanetworkopen.2023.7018