The high burden of comorbidities in Aboriginal and Torres Strait Islander Australians living with chronic hepatitis B in Far North Queensland, Australia, and the implications for patient management.

Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE

Original Publication: San Francisco, CA : Public Library of Science

Australian Aboriginal and Torres Strait Islander Peoples*/statistics & numerical data ; Carcinoma, Hepatocellular*/epidemiology ; Carcinoma, Hepatocellular*/etiology ; Hepatitis B, Chronic*/complications ; Hepatitis B, Chronic*/epidemiology ; Hepatitis B, Chronic*/therapy ; Liver Neoplasms*/epidemiology ; Liver Neoplasms*/etiology; Female ; Humans ; Male ; Middle Aged ; Australia/epidemiology ; Comorbidity ; Cross-Sectional Studies ; Liver Cirrhosis/epidemiology ; Liver Cirrhosis/etiology ; Obesity/epidemiology ; Queensland/epidemiology ; Cost of Illness ; Prevalence ; Adult ; Risk Factors ; Disease Management

Background: Aboriginal and Torres Strait Islander Australians living with chronic hepatitis B virus (HBV) infection have a significant burden of hepatocellular carcinoma (HCC). The prevalence of comorbidities that increase the risk of HCC in this population is incompletely defined.
Methods: This cross-sectional study was performed in remote tropical Queensland, Australia in January 2021. All individuals living with chronic HBV in the region were identified; the prevalence of relevant comorbidities was determined by reviewing medical records.
Results: All 236 individuals in the cohort identified as Aboriginal and Torres Strait Islander Australians; their median (interquartile range (IQR)) age was 48 (40-62) years; 120/236 (50.9%) were female. Of the 194/236 (82.2%) engaged in HBV care, 61 (31.4%) met criteria for HBV therapy and 38 (62.2%) were receiving it. However, 142/236 (60.2%) were obese, 73/236 (30.9%) were current smokers and 57/236 (24.2%) were drinking alcohol hazardously; 70/236 (29.7%) had ≥2 of these additional risk factors for HCC, only 43/236 (18.2%) had none. Among the 19 patients with confirmed cirrhosis, 9 (47%) were obese, 8 (42%) were currently-or had a history of-drinking alcohol hazardously and 5 (26.3%) were current smokers. Patients also had a median (IQR) of 3 (2-4) cardiovascular risk factors (cigarette smoking, hypertension, impaired glucose tolerance, dyslipidaemia, renal impairment/proteinuria). Only 9/236 (3.8%) did not have one of these 5 comorbidities.
Conclusions: Aboriginal and Torres Strait Islander Australians living with chronic HBV in this region of remote Australia have a high engagement with HBV care and the majority of individuals eligible for antiviral therapy are receiving it. However, a significant comorbidity burden increases their risk of cirrhosis, HCC, and premature death. It is essential to integrate chronic HBV care with management of these comorbidities-rather than focusing on HBV alone-to achieve optimal health outcomes.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: © 2023 Riddell et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Aust Fam Physician. 2013 Aug;42(8):524-7. (PMID: 23971058)
Am J Clin Oncol. 2018 Sep;41(9):874-881. (PMID: 28537989)
Med J Aust. 2020 Nov;213(9):431-431.e1. (PMID: 33030248)
Int J Cancer. 2012 Apr 1;130(7):1639-48. (PMID: 21544812)
Med J Aust. 2003 Jan 20;178(2):82-5. (PMID: 12526729)
J Hepatol. 2009 May;50(5):990-8. (PMID: 19303657)
Gastroenterology. 2018 May;154(6):1706-1718.e1. (PMID: 29425931)
J Hepatol. 2018 Mar;68(3):476-484. (PMID: 29107150)
Ann Intern Med. 2012 Mar 6;156(5):387-9. (PMID: 22393134)
Med J Aust. 2017 Feb 20;206(3):141. (PMID: 28208049)
Med J Aust. 2021 Mar;214(5):201-202.e1. (PMID: 33608890)
PLoS One. 2020 Sep 3;15(9):e0238719. (PMID: 32881958)
Int J Epidemiol. 2009 Dec;38(6):1497-511. (PMID: 19720726)
Am J Gastroenterol. 2019 Dec;114(12):1870-1877. (PMID: 31688024)
Clin Gastroenterol Hepatol. 2019 Mar;17(4):748-755.e3. (PMID: 29908364)
Aust Fam Physician. 2017 Nov;46(11):859-864. (PMID: 29101924)
Global Health. 2018 Jan 25;14(1):12. (PMID: 29368657)
J Gen Virol. 2001 Apr;82(Pt 4):883-892. (PMID: 11257194)
Am J Epidemiol. 2002 Feb 15;155(4):323-31. (PMID: 11836196)
Br J Cancer. 2007 Oct 8;97(7):1005-8. (PMID: 17700568)
Aliment Pharmacol Ther. 2009 Jul;30(1):37-47. (PMID: 19392863)
Lancet Gastroenterol Hepatol. 2018 Jun;3(6):383-403. (PMID: 29599078)
Health Serv Res. 2005 Oct;40(5 Pt 2):1620-39. (PMID: 16178999)
Aust J Rural Health. 2019 Oct;27(5):427-432. (PMID: 31241239)
Am J Trop Med Hyg. 2019 Mar;100(3):517-521. (PMID: 30675834)
Int J Equity Health. 2020 Feb 17;19(1):27. (PMID: 32066438)
Am J Gastroenterol. 2006 Mar;101(3):513-23. (PMID: 16542288)
Hepatology. 2020 Jun;71(6):2023-2032. (PMID: 31556128)
Med J Aust. 2021 Oct 18;215(8):347-348. (PMID: 34499374)
PLoS One. 2012;7(9):e44930. (PMID: 23049764)
Lancet. 2018 Apr 14;391(10129):1513-1523. (PMID: 29676281)
J Gastroenterol Hepatol. 2013 Jul;28(7):1234-41. (PMID: 23432545)
N Engl J Med. 2020 Mar 12;382(11):1018-1028. (PMID: 32160663)
Br J Cancer. 2018 Apr;118(7):1005-1012. (PMID: 29520041)
Aust N Z J Public Health. 2002 Apr;26(2):144-9. (PMID: 12054333)
J Gastroenterol Hepatol. 2020 Sep;35(9):1628-1635. (PMID: 32048317)
Clin Mol Hepatol. 2020 Jan;26(1):54-59. (PMID: 31726817)
BMC Geriatr. 2017 Oct 10;17(1):230. (PMID: 29017448)
JAMA Intern Med. 2019 May 1;179(5):633-640. (PMID: 30882847)
EClinicalMedicine. 2021 Jun 07;36:100919. (PMID: 34142069)
Circulation. 2021 Mar 16;143(11):1157-1172. (PMID: 33720773)
Lancet. 2017 May 13;389(10082):1885-1906. (PMID: 28390697)
Med J Aust. 2014 Oct 20;201(8):470-4. (PMID: 25332035)
Public Health Res Pract. 2019 Jul 31;29(2):. (PMID: 31384886)
Med J Aust. 2011 Feb 21;194(4):180-5. (PMID: 21401458)
PLoS One. 2020 Jul 22;15(7):e0236339. (PMID: 32697796)
Front Genet. 2018 Jul 19;9:261. (PMID: 30073017)
Diabet Med. 1998 Jul;15(7):539-53. (PMID: 9686693)
J Hepatol. 2005 Feb;42(2):218-24. (PMID: 15664247)
PLoS One. 2017 Sep 8;12(9):e0184082. (PMID: 28886050)
Oncology. 2012;82(5):275-89. (PMID: 22555181)
PLoS Med. 2020 Jul 28;17(7):e1003198. (PMID: 32722671)
J Hepatol. 2021 May;74(5):1234-1239. (PMID: 33465402)

Date Created: 20230406 Date Completed: 20230411 Latest Revision: 20240916

20240916

PMC10079072

10.1371/journal.pone.0284151

37023060