Disease burden of chronic hepatitis B and C patients in South Korea: a population-based 16-year cohort study

Abstract

BackgroundThe prevalence of chronic hepatitis B (CHB) and C viruses (CHC) has been studied widely, but the burden of CHB and CHC coinfection (CHB/CHC) remains to be elucidated. This study investigated the 16-year trend in the disease burden in patients with CHB and/or CHC.MethodsThis analysis used a customized database from 2002 to 2020 obtained from the Korean National Health Insurance Service. Prevalence of CHB/CHC in patients with CHB and/or CHC was analyzed for each year, sex, and type of healthcare providers. Development of cirrhosis and hepatocellular carcinoma (HCC), and overall survival were evaluated.ResultsA total of 747,476 patients (male: 53.5%) were divided into three groups: CHB (593,962; 79.5%), CHC (129,049; 17.3%), and CHB/CHC (24,465; 3.3%). Regarding age distribution, most patients were in their 30s to 60s across all groups (76.5%). Compared to patients in CHB/CHC group, those in CHC had significantly lower incidence of cirrhosis (CHB/CHC vs. CHC, adjusted hazard ratio [aHR] = 0.893, 95% confidence interval [CI] = 0.864-0.922) and HCC (aHR = 0.847, 95% CI = 0.809-0.886). The CHB and CHC groups had a lower risk of mortality compared to the CHB/CHC group. (CHB/CHC vs. CHB and CHC, aHR = 0.878 and 0.892, 95% CI = 0.852-0.905 and 0.864-0.922, respectively). CHB/CHC groups showed the highest average direct medical costs ($21,311) to HCC diagnosis compared to CHB ($19,685) and CHC ($17,650).ConclusionsCHB/CHC is burdensome in its disease progression risk and medical costs compared to monoinfection. An effective screening strategy for early management of CHB/CHC is warranted for public health in South Korea.