Abstract：
OBJECTIVE: Oral antiviral therapy with nucleos(t)ide analogues (NAs) for chronic hepatitis B (CHB) is well-tolerated and lifesaving, but real-world data on utilization are limited. We examined rates of evaluation and treatment in patients from the REAL-B consortium.
METHODS: This was a cross-sectional study nested within our retrospective multinational clinical consortium (2000-2021). We determined the proportions of patients receiving adequate evaluation, meeting AASLD treatment criteria, and initiating treatment at any time during the study period. We also identified factors associated with receiving adequate evaluation and treatment using multivariable logistic regression analyses.
RESULTS: We analyzed 12,566 adult treatment-naïve patients with CHB from 25 centers in 9 countries (mean age 47.1 years, 41.7% female, 96.1% Asian, 49.6% Western region, 8.7% cirrhosis). Overall, 73.3% (9,206 patients) received adequate evaluation. Among the adequately evaluated, 32.6% (3,001 patients) were treatment eligible by AASLD criteria, 83.3% (2,500 patients) of whom were initiated on NAs, with consistent findings in analyses using EASL criteria. On multivariable logistic regression adjusting for age, sex, cirrhosis, and ethnicity plus region, female sex was associated with adequate evaluation (adjusted odds ratio [aOR] 1.13, p = 0.004), but female treatment-eligible patients were about 50% less likely to initiate NAs (aOR 0.54, p <0.001). Additionally, the lowest evaluation and treatment rates were among Asian patients from the West, but no difference was observed between non-Asian patients and Asian patients from the East. Asian patients from the West (vs. East) were about 40-50% less likely to undergo adequate evaluation (aOR 0.60) and initiate NAs (aOR 0.54) (both p <0.001).
CONCLUSIONS: Evaluation and treatment rates were suboptimal for patients with CHB in both the East and West, with significant sex and ethnic disparities. Improved linkage to care with linguistically competent and culturally sensitive approaches is needed.
UNASSIGNED: Significant sex and ethnic disparities exist in hepatitis B evaluation and treatment, with female treatment-eligible patients about 50% less likely to receive antiviral treatment and Asian patients from Western regions also about 50% less likely to receive adequate evaluation or treatment compared to Asians from the East (there was no significant difference between Asian patients from the East and non-Asian patients). Improved linkage to care with linguistically competent and culturally sensitive approaches is needed.
METHODS: This was a cross-sectional study nested within our retrospective multinational clinical consortium (2000-2021). We determined the proportions of patients receiving adequate evaluation, meeting AASLD treatment criteria, and initiating treatment at any time during the study period. We also identified factors associated with receiving adequate evaluation and treatment using multivariable logistic regression analyses.
RESULTS: We analyzed 12,566 adult treatment-naïve patients with CHB from 25 centers in 9 countries (mean age 47.1 years, 41.7% female, 96.1% Asian, 49.6% Western region, 8.7% cirrhosis). Overall, 73.3% (9,206 patients) received adequate evaluation. Among the adequately evaluated, 32.6% (3,001 patients) were treatment eligible by AASLD criteria, 83.3% (2,500 patients) of whom were initiated on NAs, with consistent findings in analyses using EASL criteria. On multivariable logistic regression adjusting for age, sex, cirrhosis, and ethnicity plus region, female sex was associated with adequate evaluation (adjusted odds ratio [aOR] 1.13, p = 0.004), but female treatment-eligible patients were about 50% less likely to initiate NAs (aOR 0.54, p <0.001). Additionally, the lowest evaluation and treatment rates were among Asian patients from the West, but no difference was observed between non-Asian patients and Asian patients from the East. Asian patients from the West (vs. East) were about 40-50% less likely to undergo adequate evaluation (aOR 0.60) and initiate NAs (aOR 0.54) (both p <0.001).
CONCLUSIONS: Evaluation and treatment rates were suboptimal for patients with CHB in both the East and West, with significant sex and ethnic disparities. Improved linkage to care with linguistically competent and culturally sensitive approaches is needed.
UNASSIGNED: Significant sex and ethnic disparities exist in hepatitis B evaluation and treatment, with female treatment-eligible patients about 50% less likely to receive antiviral treatment and Asian patients from Western regions also about 50% less likely to receive adequate evaluation or treatment compared to Asians from the East (there was no significant difference between Asian patients from the East and non-Asian patients). Improved linkage to care with linguistically competent and culturally sensitive approaches is needed.
摘要：
目的：口服抗病毒治疗与核苷（酸）类似物（NAs）慢性乙型肝炎（CHB）是良好的耐受性和救生，但是实际的利用率数据是有限的。我们检查了REAL-B联盟患者的评估和治疗率。
方法：这是一项纳入我们的回顾性跨国临床联盟（2000-2021）的横断面研究。我们确定了接受充分评估的患者比例，符合AASLD治疗标准，并在研究期间的任何时间开始治疗。我们还使用多变量逻辑回归分析确定了与接受适当评估和治疗相关的因素。
结果：我们分析了来自9个国家的25个中心的12,566名成人治疗初治CHB患者（平均年龄47.1岁，41.7%女性，96.1%亚洲人，西部地区49.6%,8.7%的肝硬化)。总的来说,73.3%(9,206例)接受了充分的评估。在经过充分评估的人中，32.6％（3,001例）符合AASLD标准，83.3%(2,500名患者)的患者开始接受NAs，在使用EASL标准的分析中发现一致。在调整年龄的多变量逻辑回归中，性别,肝硬化,种族加地区，女性性别与适当的评估相关（调整后的比值比[aOR]1.13，p=0.004），但符合女性治疗条件的患者启动NAs的可能性降低约50%(aOR为0.54,p<0.001).此外,评价和治疗率最低的是来自西方的亚洲患者，但在非亚洲患者和来自东方的亚洲患者之间没有观察到差异.来自西方的亚洲患者（与East）进行适当评估（aOR0.60）和启动NAs（aOR0.54）（均p<0.001）的可能性降低了约40-50％。
结论：在东部和西部，CHB患者的评价和治疗率均不理想，性别和种族差异很大。需要改善与语言能力和文化敏感性方法的联系。
■在乙型肝炎评估和治疗中存在显著的性别和种族差异，与来自东方的亚洲人相比,符合女性治疗条件的患者接受抗病毒治疗的可能性降低约50%,来自西方地区的亚洲患者接受适当评估或治疗的可能性也降低约50%(亚洲患者与东方患者与非亚洲患者之间没有显著差异).需要改善与语言能力和文化敏感性方法的联系。
方法：这是一项纳入我们的回顾性跨国临床联盟（2000-2021）的横断面研究。我们确定了接受充分评估的患者比例，符合AASLD治疗标准，并在研究期间的任何时间开始治疗。我们还使用多变量逻辑回归分析确定了与接受适当评估和治疗相关的因素。
结果：我们分析了来自9个国家的25个中心的12,566名成人治疗初治CHB患者（平均年龄47.1岁，41.7%女性，96.1%亚洲人，西部地区49.6%,8.7%的肝硬化)。总的来说,73.3%(9,206例)接受了充分的评估。在经过充分评估的人中，32.6％（3,001例）符合AASLD标准，83.3%(2,500名患者)的患者开始接受NAs，在使用EASL标准的分析中发现一致。在调整年龄的多变量逻辑回归中，性别,肝硬化,种族加地区，女性性别与适当的评估相关（调整后的比值比[aOR]1.13，p=0.004），但符合女性治疗条件的患者启动NAs的可能性降低约50%(aOR为0.54,p<0.001).此外,评价和治疗率最低的是来自西方的亚洲患者，但在非亚洲患者和来自东方的亚洲患者之间没有观察到差异.来自西方的亚洲患者（与East）进行适当评估（aOR0.60）和启动NAs（aOR0.54）（均p<0.001）的可能性降低了约40-50％。
结论：在东部和西部，CHB患者的评价和治疗率均不理想，性别和种族差异很大。需要改善与语言能力和文化敏感性方法的联系。
■在乙型肝炎评估和治疗中存在显著的性别和种族差异，与来自东方的亚洲人相比,符合女性治疗条件的患者接受抗病毒治疗的可能性降低约50%,来自西方地区的亚洲患者接受适当评估或治疗的可能性也降低约50%(亚洲患者与东方患者与非亚洲患者之间没有显著差异).需要改善与语言能力和文化敏感性方法的联系。
