Epidemiology and natural history of chronic Hepatitis B in the Canadian province of Alberta from 2012 to 2021: A population-based study.

Introduction and Objectives: There are limited recent data on the burden of chronic hepatitis B (CHB) in the North American general population. We aimed to identify the CHB burden from a Canadian population-based perspective.
Patients and Methods: Using a retrospective cohort design, we searched Alberta Analytics administrative databases including the Provincial Laboratory database, to describe CHB epidemiology and natural history in Alberta, Canada between fiscal years 2012-2020. We analyzed incidence and prevalence trends using a Poisson regression model and conducted Kaplan-Meier analyses to examine the incident cohort's survival.
Results: The age/sex-adjusted incidence of CHB between 2015-2020 was 27.1/100,000 person/years (29.6/100,000 in males and 24.5/100,000 in females) and was highest among individuals aged 45-64 years. Despite a decrease in annual incidence of CHB from 36.4 to 13.4/100,000 between 2015-2020, prevalence increased from 98.9 to 210.3/100,000 in the same period. Of 6,860 incident cases, 2.1% died, and 0.2% underwent liver transplantation during a median follow-up of 3.6 years (interquartile range 2.0-4.9 years). CHB patients had significantly lower survival rates compared to age/sex-matched Canadians, with a standardized mortality ratio of 3.9 (95% confidence interval [CI] 3.3-4.6). Male sex (hazard ratio [HR] 1.7; 95% CI 1.2-2.5), older age at diagnosis (HR, 1.08; 95% CI 1.07-1.09) independently predicted mortality.
Conclusions: CHB incidence decreased in Alberta, which is consistent with nationwide trends. Males and individuals aged 45-64 had higher CHB incidence and prevalence. CHB patients' lower survival rates emphasize the need to address barriers to guideline recommended HBV care linkage.
Competing Interests: Declaration of interests Dr. Golasa Samadi Kochaksaraei: No conflict of interest to declare. Ms. Fengjuan Yang: No conflict of interest to declare. Professor Cynthia Seow: Advisory Boards: Janssen, Abbvie, Takeda, Pfizer, Fresenius Kabi, Bristol Myers Squibb, Pharmascience, Lilly. Speaker: Janssen, Abbvie, Takeda, Pfizer, Fresenius Kabi. Professor Herman Barkema: Advisory Boards: Dairy Farmers of Canada, Alberta Milk, Public Health Agency of Canada, Genome Canada. Speaker: BioMerieux, HIPRA, Merck, Alberta Milk, Public Health Agency of Canada, China Agriculture University, Lactanet. Funding: AAFC, Dairy Farmers of Canada, RDAR, Alberta Innovates, Alberta Health, Alberta Milk, Lactanet, Genome Alberta, Genome Canada, JPIAMR, WHO. Professor Carla Coffin: Advisory/ Consulting boards: Altimmune Pharmaceuticals, Janssen, Roche, Gilead (paid to the University of Calgary, c/o the Canadian HBV Network) and personal fees (Gilead). Grants, clinical trials, materials: Investigator Initiated, Gilead, GSK, Janssen (paid to the University of Calgary c/o the Canadian HBV Network and/or support of preclinical studies. Associate Professor Abdel-Aziz Shaheen. Advisory/ Consulting boards: Gilead and Novo Nordisk. Grants, clinical trials, materials: Investigator Initiated, Gilead.
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