Chronic Hepatitis B Prevalence and Care Among Medicaid Beneficiaries.

Abstract

Background: Monitoring and antiviral treatment are essential to reduce chronic hepatitis B (CHB)-related morbidity and mortality.

Methods: We analyzed Medicaid claims data from January 1, 2016, through December 31, 2019, to estimate claims-recorded CHB prevalence and to evaluate CHB-directed monitoring, antiviral use, and qualifying liver imaging.

Results: Among 72.4 million adult Medicaid beneficiaries, 292,267 had claims-recorded CHB diagnosis (0.40%). After excluding beneficiaries with HIV or hepatitis C, HCC, or liver transplantation, 208,933 remained in the care-analysis cohort. Non-Hispanic Asians represented 6.2% of Medicaid beneficiaries but 42.8% of the care-analysis cohort. CHB-directed monitoring was received by 53.4% overall and 66.9% of patients with cirrhosis; antiviral use by 12.8% overall and 35.9% of those with cirrhosis. More than 90% of patients with cirrhosis had ≥1 qualifying liver imaging; among patients without cirrhosis, 73.5% of men aged 40 years or older and 74.9% of women aged 50 years or older had liver imaging. Non-Hispanic Asian and Native Hawaiian/Pacific Islander beneficiaries were significantly more likely to receive CHB-directed monitoring and antiviral therapy than non-Hispanic White beneficiaries, whereas Hispanic beneficiaries were significantly less likely. Substantial state-level variation was observed; among patients with cirrhosis, CHB-directed monitoring ranged from 51.4% to 89.8% and antiviral use from 21.1% to 51.5%.

Conclusion: Substantial gaps and disparities in CHB monitoring and antiviral use persist among Medicaid beneficiaries highlighting the urgent need for targeted interventions and integration of CHB care into Medicaid quality measures. Standardizing CHB care and reducing demographic and geographic disparities are critical steps toward minimizing CHB-related complications and mortality.