S1198 Treatment and Hepatocellular Carcinoma Screening Patterns Among Black Patients With Chronic Hepatitis B

Introduction: Significant racial disparities exist in Hepatitis B virus (HBV) infection across the nation, from screening variability to treatment patterns and clinical outcomes. The Black community bears a disproportionately large disease burden. In this study, we sought to compare the disease courses between Black patients seen at a private tertiary referral center vs. those evaluated at a high-volume county safety net hospital. Methods: Using informatics, we identified adult patients with chronic HBV based on ICD-10 codes, who had ≥1 clinic visit between January 1, 2010 and December 31, 2020 at University of Miami Hospital (UM) and Jackson Memorial Hospital (JM). We conducted retrospective chart review to gather demographic and clinical data. We used descriptive statistics, Kruskal-Wallis, and Pearson’s chi squared tests to evaluate for differences between Black patients at each hospital with the significance interval set to p < 0.05. Analyses were conducted using STATA 17.0. Results: Of 649 Black patients detected by informatics, 364 had confirmed HBV with 306 seen at UM and 58 at JM. Compared to JM, UM patients were significantly older, English speakers, and privately insured (p < 0.001) (Table). Most common birth countries included Haiti and the USA, among others (Figure). 78.8% of UM patients were evaluated by Hepatology, compared to 41.1% at JM. More JM patients had active hepatitis, and 15.5% had a high viral load (HBV DNA PCR >20,000) compared to 3.3% at UM. Patients seen at UM were more likely to be treated, 52.9%, vs. 24.6% at JM and placed on newer regimens (ie Tenofovir [TAF] and Entecavir). UM patients were significantly more likely to undergo HbeAg and HbeAb testing, compared to their JM counterparts. Black patients at JM were significantly more likely to have alcoholic liver disease, ascites, and orthotopic liver transplantation. Although more UM patients underwent surveillance for hepatocellular carcinoma (HCC), there was ultimately no significant difference in patients being diagnosed with HCC between hospitals. Conclusion: These findings suggest that significant differences in demographics, referral patterns, laboratory evaluation, and management exist between Black patients at UM vs. JM, despite both hospitals being affiliated with the same academic institution. Our analysis on JM patients is ongoing and will be crucial to inform future interventions aimed at standardizing and providing evidence-based HBV care across medical centers.Figure 1.: Geographic distribution of Black patients’ most common birth countries. Green UM, Orange JM. Table 1. - Comparison of demographics, screening, and management patterns between Black patients at JM vs. those at UM Variable Blacks @ JM (n = 58) Blacks @ UM (n = 306) p-value Median Age, years (IQR) 54 (45-63) 59 (47-66) 0.0001 Male Gender, % 68.3 63.7 0.24 US Born, % 50.9 32.7 0.012 Department seen by, %Hepatology 41.4 78.8 < 0.001 General Internal MedGastroenterology 62.11.7 8.814.1 < 0.0010.008 HbeAg / HbeAb checked, % 52.6 78.5 < 0.001 Active hepatitis, % 19 2.9 < 0.001 High viral load ( >20,000), % 15.5 3.3 < 0.001 Currently on Treatment, % 24.6 52.9 < 0.001 Tenofovir TDF TAF EntecavirAdefovirLamivudine 13.813.713.113.40.68.6 31.412.11.75.201.6 0.0070.740.00140.0780.540.003 Alcoholic Liver Disease, % 14 1.8 < 0.001 Ascites, % 22.8 7.3 < 0.001 OLT, % 26.3 1.8 < 0.001 HCC Screening, %FibroscanAFPSurveillance imaging (< 6 months) 17.542.1158.9 3178.377.9 0.04< 0.0010.003 Diagnosed with HCC 5.1 5.9 0.71 AFP = alpha-fetoprotein; OLT = orthotopic liver transplantation; HCC = hepatocellular carcinoma.