Late Diagnoses of Chronic Hepatitis B in the US: A Growing Concern

A recent study highlights a troubling trend in the diagnosis of chronic hepatitis B in the United States, revealing that over 75% of cases are identified late, often only during the evaluation of liver complications. This retrospective analysis, which utilized the Truven MarketScan database from 2007 to 2021, underscores the urgent need for enhanced screening protocols to mitigate adverse health outcomes.

The study, led by researchers Michael Le and Joanne K. Liu from Stanford University Medical Center, analyzed the medical records of 2,608 patients with chronic hepatitis B. The findings indicate that 76.6% of these patients received a late diagnosis, defined as occurring within two years before or after the onset of liver complications such as cirrhosis, hepatocellular carcinoma (HCC), or the need for liver transplantation. Alarmingly, 44.5% were diagnosed at or within six months of their first liver complication, highlighting missed opportunities for earlier intervention.

According to the study, which was published in the journal Alimentary Pharmacology & Therapeutics in June 2025, 75.5% of patients diagnosed late had no recorded medical visits prior to their first liver complication. Among those diagnosed more than 36 months after the initial liver complication, 46% had already developed another liver disease. This trend persisted despite advancements in treatment, as the rate of late diagnosis remained relatively stable from 2010 to 2019.

"Our study suggests that the majority of hepatitis B virus diagnoses in the United States are likely incidental, stemming from investigations for liver complications. These individuals represent missed opportunities for timely treatment and intervention to prevent disease progression and serious hepatic outcomes," explained Dr. Liu.

The implications of these findings are significant. The late diagnosis of chronic hepatitis B leads to a higher incidence of severe liver conditions; among those diagnosed late, 91% had cirrhosis, 81.5% presented with decompensated cirrhosis, and 30.8% developed HCC. Notably, independent predictors of late diagnosis included male sex, alcohol consumption, and insurance type, particularly those enrolled in Preferred Provider Organizations (PPO) or hybrid plans.

The study's limitations include its exclusion of uninsured individuals and those covered by government insurance programs such as Medicaid, potentially underrepresenting higher-risk populations. Furthermore, the reliance on claims data may have impacted the accuracy of diagnosis rates, as the study lacked data on race, ethnicity, and foreign-born status, which are critical factors in understanding hepatitis B prevalence.

Despite the challenges, experts advocate for more proactive screening measures. Dr. Sarah Johnson, an epidemiologist at the University of California, Los Angeles, emphasized, "Improving screening practices for hepatitis B is crucial, especially in high-risk populations. Early detection can significantly change the prognosis for patients and reduce the burden of liver-related complications."

As the U.S. healthcare system grapples with these findings, the importance of public health initiatives aimed at increasing awareness and accessibility to hepatitis B screenings has never been clearer. Failure to address these diagnostic delays may result in continued health disparities and increased morbidity and mortality associated with chronic liver diseases.

In conclusion, the retrospective analysis by Le and Liu serves as a call to action for healthcare providers to prioritize early diagnosis and treatment of chronic hepatitis B. Enhanced screening protocols could pave the way for better patient outcomes and a reduction in the prevalence of severe liver conditions linked to late diagnoses.