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Press release

Hepatitis B Is Globally Underassessed and Undertreated, Especially Among Women and Asian Minorities in the West

Amsterdam | May 2, 2024

Targeted outreach to eliminate the disease by 2030 is required, experts say in the Journal of Hepatology

New evidence reveals global underassessment and undertreatment of chronic hepatitis B (HBV), especially among women and Asian minorities in the West, a new studyopens in new tab/window in the Journal of Hepatologyopens in new tab/window, published by Elsevier, details.

"In clinical practice we continue to see patients with advanced liver disease due to HBV despite having vaccines for prevention and excellent oral therapy for those who are treatment eligible. Simplifying and broadening HBV management is crucial," according to the researchers.

With the World Health Organization's goal to eliminate viral hepatitis by 2030 fast approaching, targeted outreach is needed to reduce new infections and deaths. This new research provides practitioners and policymakers with strong data to further improve current guidance on meeting this goal as well as helping to improve patient outcomes.

Lead investigator Mindie H. Nguyen, MD, MAS, AGAF, FAASLD, Division of Gastroenterology and Hepatology, Stanford University Medical Center and Department of Epidemiology and Population Health, Stanford University School of Medicine, explains, "We conducted a large-scale study using a global cohort of patients with HBV, drawn from academic and referral practices, to identify patterns in treatment utilization. Our aim was to assist in developing more robust case finding guidelines, which we believe should also be tailored for nonspecialist primary care providers and resource-limited settings. Our multinational real-world study of patients with chronic HBV revealed that rates of treatment evaluation and initiation remain below optimal levels, even among patients with cirrhosis and patients from referral practices.”

For this study researchers examined the evaluation and treatment rates of patients from the REAL-B consortium, a global collaboration of experts from 25 study centers across nine countries who treat patients with HBV.

Key findings uncovered by investigators are:

Among 12,566 patients with chronic HBV infection, about one-quarter were not adequately evaluated.

Among adequately evaluated patients, about one-third were treatment eligible by international guidelines.

Among those who were treatment eligible, about 80-85% were treated.

Significant sex disparities: Females were more likely to undergo adequate evaluation, but were 50% less likely to initiate treatment when indicated.

Ethnic disparities: Asian patients from the West were about 40-50% less likely to undergo adequate evaluation or initiate antiviral treatments when indicated, as compared to Asian patients from the East, possibly due to lack of cultural understanding.

Oral antiviral therapy with nucleos(t)ide analogs for chronic HBV is well-tolerated and lifesaving, but real-world utilization data are limited.

Dr. Nguyen emphasizes, "It is vitally important to understand what the continual barriers are to treatment for patients with HBV. Our research leads us to speculate that there may be additional barriers for Asian patients in the West, including language and cultural factors, in addition to other socioeconomic factors."

She adds, "The large number of Asian patients in our study is largely a reflection of the global HBV disease burden, which is the largest in the Western Pacific region and among immigrants from this region who are now residing in the West. In a recent US population-based study, the highest prevalence of HBV infection was observed in the Asian population (3.4%) followed by the Black population (0.69%). Additional studies are needed to evaluate our study's outcomes in other racial and ethnic groups that may be disproportionately affected by HBV, such as those from the Africa region."

Chronic HBV affects approximately 275 to 316 million people worldwide and contributed to 555,000 deaths in 2019. Up to one-fifth of individuals with the disease progress to cirrhosis, 20% of whom develop hepatic decompensation and 15% hepatocellular carcinoma.

Notes for editors

The article is “Sex and ethnic disparities in hepatitis B evaluation and treatment across the world," by Sahith Kudaravalli, Daniel Q. Huang, Ming-Lun Yeh, Lindsey Trinh, P.C. Tsai, Yao-Chun Hsu, Leslie Y. Kam, Vy H. Nguyen, Eiichi Ogawa, Dong Hyun Lee, Takanori Ito, Tsunamasa Watanabe, Masaru Enomoto, Carmen Monica Preda, Michael K.L. Ko, Rex Wan-Hin Hui, Masanori Atsukawa, Takanori Suzuki, Sebastian Marciano, Ana Barreira, Son Do, Haruki Uojima, Hirokazu Takahashi, Sabrina X.Z. Quek, Htet Htet Toe Wai Khine, Masatoshi Ishigami, Norio Itokawa, Min Seok Go, Ritsuzo Kozuka, Raluca Ioana Marin, Irina Sandra, Jiayi Li, Jian Q. Zhang, Christopher Wong, Yoko Yoshimaru, Dang K.H. Vo, Cheng-Hao Tseng, Chul-jin Lee, Kaori Inoue, Mayumi Maeda, Joseph K. Hoang, Angela Chau, Wan-Long Chuang, Chia-Yen Dai, Jee-Fu Huang, Chung-Feng Huang, Maria Buti, Yasuhito Tanaka, Adrian Carlos Gadano, Man-Fung Yuen, Ramsey Cheung, Seng Gee Lim, Huy N. Trinh, Hidenori Toyoda, Ming-Lung Yu, and Mindie H. Nguyen ( in new tab/window). It appears online in advance of the Journal of Hepatology, volume 81, issue 1 (July 2024) published by Elsevier.

The article is openly available for 30 days at in new tab/window.

Full text of this article is also available to credentialed journalists upon request; contact Freya Weise at +33 (1) 71 16 55 00 or [email protected]opens in new tab/window. Journalists wishing to interview the authors should contact Mindie H. Nguyen, MD, MAS, at [email protected]opens in new tab/window.

About the Journal of Hepatology

The Journal of Hepatologyopens in new tab/window, the premier journal devoted to liver diseases, is the official journal of the European Association for the Study of the Liver (EASL). It publishes original papers, reviews, case reports, and letters to the Editor concerned with clinical and basic research in the field of hepatology. The journal has a 2022 Impact Factor of 25.7 (Source: Journal Citation Reports™ from Clarivate, 2023). www.journal-of-hepatology.euopens in new tab/window

About EASL

In the fifty plus years since EASLopens in new tab/window was founded, it has grown from a small organization that played host to 70 participants at its first meeting, to becoming the leading international liver association. EASL attracts the foremost hepatology experts as members and has an impressive track record in promoting research in liver disease, supporting wider education, and promoting changes in European liver policy.www.easl.euopens in new tab/window

About Elsevier

As a global leader in scientific information and analytics, Elsevier helps researchers and healthcare professionals advance science and improve health outcomes for the benefit of society. We do this by facilitating insights and critical decision-making with innovative solutions based on trusted, evidence-based content and advanced AI-enabled digital technologies.

We have supported the work of our research and healthcare communities for more than 140 years. Our 9,500 employees around the world, including 2,500 technologists, are dedicated to supporting researchers, librarians, academic leaders, funders, governments, R&D-intensive companies, doctors, nurses, future healthcare professionals and educators in their critical work. Our 2,900 scientific journals and iconic reference books include the foremost titles in their fields, including Cell Press, The Lancet and Gray’s Anatomy.

Together with the Elsevier Foundationopens in new tab/window, we work in partnership with the communities we serve to advance inclusion and diversity in science, research and healthcare in developing countries and around the world.

Elsevier is part of RELXopens in new tab/window, a global provider of information-based analytics and decision tools for professional and business customers. For more information on our work, digital solutions and content, visit



Freya Weise, MD, PhD


+33 (6) 28 51 59 51

E-mail Freya Weise, MD, PhD