Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jan 27, 2019; 11(1): 86-98
Published online Jan 27, 2019. doi: 10.4254/wjh.v11.i1.86
Clinical factors associated with hepatitis B screening and vaccination in high-risk adults
Rotimi Ayoola, Sebastian Larion, David M Poppers, Renee Williams
Rotimi Ayoola, Department of Medicine, Division of Gastroenterology, Howard University, Washington, DC 20059, United States
Sebastian Larion, Department of Medicine, Augusta University, Augusta, Georgia 30912, United States
David M Poppers, Renee Williams, Department of Medicine, Division of Gastroenterology, New York University Langone Health, New York, NY 10016, United States
Author contributions: Ayoola R was involved in the study concept design, acquisition of data, and drafting of the manuscript; Larion S was involved in the study concept and design, analysis and interpretation of data, and drafting the manuscript; Poppers DM was involved in the critical revision of the manuscript for important intellectual content. Williams R was involved in the study concept and design, critical revision of the manuscript for important intellectual content, and study supervision.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board at New York University/New York Langone Health.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous retrospective clinical data. The study analyzed only existing data that spanned multiple years, and included a large number of patients hindering the ability to obtain retrospective consent from all patients. The study was descriptive in nature and lacked identifying patient information.
Conflict-of-interest statement: We have no relevant financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Rotimi Ayoola, MD, Doctor, Department of Medicine, Division of Gastroenterology, Howard University, 2041 Georgia Avenue NW, Washington, DC 20059, United States. rayoola@huhosp.org
Telephone: +1-404-4013645 Fax: +1-202-8657199
Received: September 5, 2018
Peer-review started: September 6, 2018
First decision: November 14, 2018
Revised: November 27, 2018
Accepted: January 9, 2019
Article in press: January 9, 2019
Published online: January 27, 2019
Abstract
BACKGROUND

Hepatitis B virus is a viral infection that can lead to acute and/or chronic liver disease, and hepatocellular carcinoma (HCC). Hepatitis B vaccination is 95% effective in preventing infection and the development of chronic liver disease and HCC due to hepatitis B. In 2011, the Centers for Disease Control updated their guidelines recommending that adults at high-risk for hepatitis B infection be vaccinated against hepatitis B including those with diabetes mellitus (DM). We hypothesize that adults at high-risk for hepatitis B infection are not being adequately screened and/or vaccinated for hepatitis B in a large urban healthcare system.

AIM

To investigate clinical factors associated with Hepatitis B screening and vaccination in patients at high-risk for Hepatitis B infection.

METHODS

We conducted a retrospective review of 999 patients presenting at a large urban healthcare system from 2012-2017 at high-risk for hepatitis B infection. Patients were considered high-risk for hepatitis B infection based on hepatitis B practice recommendations from the Center for Disease Control. Medical history including hepatitis B serology, concomitant medical diagnoses, demographics, insurance status and social history were extracted from electronic health records. Multivariate logistic regression was used to identify clinical risk factors independently associated with hepatitis B screening and vaccination.

RESULTS

Among the 999 patients, 556 (55.7%) patients were screened for hepatitis B. Of those who were screened, only 242 (43.5%) patients were vaccinated against hepatitis B. Multivariate regression analysis revealed end-stage renal disease [odds ratio (OR): 5.122; 2.766-9.483], alcoholic hepatitis (OR: 3.064; 1.020-9.206), and cirrhosis or end-stage liver disease (OR: 1.909; 1.095-3.329); all P < 0.05 were associated with hepatitis B screening, while age (OR: 0.785; 0.680-0.906), insurance status (0.690; 0.558-0.854), history of DM (OR: 0.518; 0.364-0.737), and human immunodeficiency virus (OR: 0.443; 0.273-0.718); all P < 0.05 were instead not associated with hepatitis B screening. Of the adults vaccinated for hepatitis B, multivariate regression analysis revealed age (OR: 0.755; 0.650-0.878) and DM were not associated with hepatitis B vaccination (OR: 0.620; 0.409-0.941) both P < 0.05.

CONCLUSION

Patients at high-risk for hepatitis B are not being adequately screened and/or vaccinated. Improvements in hepatitis B vaccination should be strongly encouraged by all healthcare systems.

Keywords: Health prevention, Vaccination, Hepatitis B virus, Screening, Diabetes mellitus, Cirrhosis, End-stage renal disease, Human immunodeficiency virus, Intravenous drug users

Core tip: This is a retrospective study evaluating clinical factors associated with Hepatitis B virus (HBV) screening and vaccination in high-risk adults. Among the 999 high-risk adults included in this study, 556 (55.7%) adults were screened for HBV. Of those who were screened, only 242 (43.5%) adults were vaccinated against HBV. Clinical factors such as End Stage Renal Disease, and cirrhosis were associated with HBV screening, while diabetes mellitus (DM) was not. Patients with DM were less likely to undergo HBV vaccination. HBV vaccination is highly effective in preventing HBV-related liver disease and its sequelae. Increasing HBV vaccination in all high-risk adults should be strongly encouraged by all healthcare systems.