Journal of Viral Hepatitis (OnlineEarly Articles).
doi:10.1111/j.1365-2893.2007.00893.x

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Abstract
Incidence of hepatocellular carcinoma among individuals with hepatitis B virus
infection identified using an automated data algorithm

M. Ulcickas Yood1,2,31Josephine Ford Cancer Center, Henry Ford Health System,
Detroit, MI2Epidemiology and Public Health, Yale University School of Medicine,
New Haven, CT3EpiSource, Hamden, CT, C. P. Quesenberry Jr44Division of Research,
Kaiser Permanente Medical Care Program, Oakland, CA, D. Guo5,65Global
Epidemiology and Outcomes Research, Bristol Myers Squibb Company, Wallingford,
CT6Global Epidemiology and Outcomes Research, Bristol Myers Squibb Company,
Plainsboro, NJ, K. Wells11Josephine Ford Cancer Center, Henry Ford Health
System, Detroit, MI, J. Shan44Division of Research, Kaiser Permanente Medical
Care Program, Oakland, CA, L. Sanders5,65Global Epidemiology and Outcomes
Research, Bristol Myers Squibb Company, Wallingford, CT6Global Epidemiology and
Outcomes Research, Bristol Myers Squibb Company, Plainsboro, NJ, M. L.
Skovron5,65Global Epidemiology and Outcomes Research, Bristol Myers Squibb
Company, Wallingford, CT6Global Epidemiology and Outcomes Research, Bristol
Myers Squibb Company, Plainsboro, NJ, U. Iloeje5,65Global Epidemiology and
Outcomes Research, Bristol Myers Squibb Company, Wallingford, CT6Global
Epidemiology and Outcomes Research, Bristol Myers Squibb Company, Plainsboro,
NJ, C. Caldwell77Yale New Haven Hospital, New Haven, CT, USA and M. M.
Manos44Division of Research, Kaiser Permanente Medical Care Program, Oakland,
CA1Josephine Ford Cancer Center, Henry Ford Health System, Detroit, MI;
2Epidemiology and Public Health, Yale University School of Medicine, New Haven,
CT; 3EpiSource, Hamden, CT; 4Division of Research, Kaiser Permanente Medical
Care Program, Oakland, CA; 5Global Epidemiology and Outcomes Research, Bristol
Myers Squibb Company, Wallingford, CT; 6Global Epidemiology and Outcomes
Research, Bristol Myers Squibb Company, Plainsboro, NJ; and 7Yale New Haven
Hospital, New Haven, CT, USA
Marianne Ulcickas Yood DSc, MPH, 275 Blue Trail, Suite 3, Hamden, CT 06518, USA.

E-mail: muyood@...

Summary. The purpose of this study was to develop an algorithm for identifying
patients with chronic hepatitis B virus (HBV) using automated data sources from
two US health systems and evaluate the algorithm’s performance by quantifying
the incidence of hepatocellular carcinoma (HCC) among chronic HBV patients. To
allow comparisons with estimates from automated databases that may not contain
all data elements used in this algorithm, we created three definitions of
chronic HBV infection and used these definitions to create three overlapping
cohorts. We compared the incidence of HCC in each cohort with the incidence of
HCC in a matched general population comparison cohort with no evidence of HBV.
Patients who met the most stringent criteria for chronic HBV infection (based on
the standard definition of 6 months of infection using repeat laboratory tests
and record review) were 146 times more likely to develop HCC than matched
comparison patients (adjusted hazard ratio = 146.5, 95% CI: 74.0–289.8). Those
not meeting the stringent criteria, but who met the criterion of at least one
positive hepatitis B surface antigen test were 30 times more likely to develop
HCC than comparison patients (adjusted hazard ratio = 29.8, 95% CI: 16.5–53.6).
Finally, patients who met the criterion based on at least one HBV diagnosis were
38 times more likely to develop HCC than matched comparison patients (adjusted
hazard ratio = 37.8, 95% CI: 25.9–55.1). The magnitude of the relative increase
in HCC risk seen using different criteria used to define HBV infection indicate
that these automated data algorithms can identify patients with chronic HBV
infection.

http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2893.2007.00893.x
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