Optimizing hepatitis B virus screening in the United States using a simple demographics‐based model

Abstract

Background and Aims: Chronic hepatitis B (CHB) affects >290 million persons globally, and only 10% have been diagnosed, presenting a severe gap that must be addressed. We developed logistic regression (LR) and machine learning (ML; random forest) models to accurately identify patients with HBV, using only easily obtained demographic data from a populationbased data set. Approach and Results:We identified participants with data on HBsAg, birth year, sex, race/ethnicity, and birthplace from 10 cycles of the National Health and Nutrition Examination Survey (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018) and divided them into two cohorts: training (cycles 2, 3, 5, 6, 8, and 10; n = 39,119) and validation (cycles 1, 4, 7, and 9; n = 21,569). We then developed and tested our two models. The overall cohort was 49.2% male, 39.7% White, 23.2% Black, 29.6% Hispanic, and 7.5% Asian/other, with a median birth year of 1973. In multivariable logistic regression, the following factors were associated with HBV infection: birth year 1991 or after (adjusted OR [aOR], 0.28; p < 0.001); male sex (aOR, 1.49; p = 0.0080); Black and Asian/other versus White (aOR, 5.23 and 9.13; p < 0.001 for both); and being USA-born (vs. foreign-born; aOR, 0.14; p < 0.001). We found that the ML model consistently outperformed the LR model, with higher area under the receiver operating characteristic values (0.83 vs. 0.75 in validation cohort; p < 0.001) and better differentiation of highand low-risk persons. Conclusions:Our ML model provides a simple, targeted approach to HBV screening, using only easily obtained demographic data.

Prevalence of Cirrhosis/Advanced Fibrosis Among HBsAg-Negative and HBcAb-Positive US Adults: A Nationwide Population-Based Study

“…Given the large population base of HBsAg-negative/HBcAb-positive people (about 10 million in the USA), screening the entire HBsAg-negative/HBcAb-positive population for cirrhosis/advanced fibrosis is unlikely to be cost-effective. “Semi-targeted” approaches based on minority demographic characteristics readily available from electronic health records (such as age, sex, and race/ethnicity) may enhance screening and diagnosis [ 22 ]. For this purpose, using multivariate analysis by regression to determine factors associated with cirrhosis among the HBsAg-negative and HBcAb-positive population, we found that gender, age, race, education, comorbidities, income, and HBsAb were significant factors.…”

High prevalence of chronic viral hepatitis B and C in Minnesota Somalis contributes to rising hepatocellular carcinoma incidence

“…The results of this study suggest a need to develop strategies to improve awareness of chronic hepatitis[ 49 ], increase screening for chronic HBV and HCV infections in the immigrant Somali community in the United States and promote hepatitis B vaccination in unvaccinated children and adults. These strategies could help prevent chronic liver disease and HCC, increase access to currently available treatments that suppress HBV viral load or cure HCV and substantially reduce the burden of hepatobiliary malignancies observed in Minnesota’s non-Hispanic Black population[ 50 - 52 ]. Ahmed Mohammed et al [ 53 ] reported that visits to gastrointestinal/hepatologist specialists were linked to increased HCC surveillance in Minnesota residents, as compared to primary care practitioner visits.…”

Letter to the editor: Importance of universal screening for chronic hepatitis B infection in adults in the United States

“…We thank Dr. Cohen and colleagues for their interest in our manuscript, and for highlighting important issues surrounding HBV screening and advocating for universal screening. [1] Our manuscript was motivated by a desire to improve the status quo regarding HBV screening. Existing recommendations endorsed by the Centers for Disease Control are cumbersome and include stigmatizing information including illicit drug use history, human immunodeficiency virus status, and country of birth.…”

“…For example, gadolinium chelates such as gadobenate dimeglumine (BOPTA) are known to cause a release of histamine, [1] as well as to enhance glutathione levels. [2] Such effects on endogenous choleretics could lead to increased bile flow that is only indirectly correlated to the concentrations of BOPTA in hepatocytes.…”