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Mental and physical health status among chronic hepatitis B patients

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Little is known about health-related quality of life (HRQoL) in patients with chronic hepatitis B virus (CHB) infection in the United States. Our goal is to understand factors associated with HRQoL in this population.


We conducted a survey to assess HRQoL and behavioral risks among patients with CHB infection from four large U.S. health care systems. Primary outcomes were generated from the SF-8 scale to assess HRQoL, as measured by the mental component scores (MCS) and physical component scores (PCS). The survey also measured socio-demographic information, hepatitis-related behavioral risk factors, treatment exposure/history, stress, and social support. We supplemented survey data with electronic health records data on patient income, insurance, disease severity, and comorbidities. Multivariate analysis was used to estimate and compare adjusted least square means of MCS and PCS, and examine which risk factors were associated with lower MCS and PCS.


Nine hundred sixty-nine patients (44.6%) responded to the survey. Current life stressors and unemployment were associated with both lower MCS and PCS results in multivariate analyses. Lower MCS was also associated with White race and low social support, while lower PCS was also associated with Medicaid insurance.


Stressful life events and unemployment were related to mental and physical health status of CHB patients. Those who have social support have better mental health; White and Medicaid patients are more likely to have poorer mental and physical health, respectively. Management of CHB patients should include stress management, social support, and financial or employment assistance.

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  1. Roberts, H., Kruszon-Moran, D., Ly, K. N., Hughes, E., Iqbal, K., Jiles, R. B., et al. (2016). Prevalence of chronic hepatitis B virus (HBV) infection in U.S. households: National Health and Nutrition Examination Survey (NHANES), 1988–2012. Hepatology,63(2), 388–397.

    Article  CAS  PubMed  Google Scholar 

  2. Mayo, N. (Ed.). (2015). Dictionary of quality of life and health outcomes measurement (Mayo, N.). Milwaukee, WI: International Society for Quality of Life Research.

    Google Scholar 

  3. Prince, M., Patel, V., Saxena, S., Maj, M., Maselko, J., Phillips, M. R., et al. (2007). No health without mental health. The Lancet,370(9590), 859–877.

    Article  Google Scholar 

  4. Kendir, C., van den Akker, M., Vos, R., & Metsemakers, J. (2018). Cardiovascular disease patients have increased risk for comorbidity: A cross-sectional study in the Netherlands. European Journal of General Practice,24(1), 45–50.

    Article  PubMed  Google Scholar 

  5. Bhatti, Z., Salek, M., & Finlay, A. (2011). Chronic diseases influence major life changing decisions: A new domain in quality of life research. Journal of the Royal Society of Medicine,104(6), 241–250.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Bondini, S., Kallman, J., Dan, A., Younoszai, Z., Ramsey, L., Nader, F., et al. (2007). Health-related quality of life in patients with chronic hepatitis B. Liver International,27(8), 1119–1125.

    Article  PubMed  Google Scholar 

  7. Kim, S. J., Han, K. T., Lee, S. Y., & Park, E. C. (2015). Quality of life correlation with socioeconomic status in Korean hepatitis-B patients: A cross sectional study. Health and Quality of Life Outcomes,13(1), 55–67.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Ferreira, F. A., de Almeida-Neto, C., Teixeira, M. C., & Strauss, E. (2015). Health-related quality of life among blood donors with hepatitis B and hepatitis C: Longitudinal study before and after diagnosis. Revista Brasileira de Hematologia e Hemoterapia,37(6), 381–387.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Abedi, G., Rostami, F., & Nadi, A. (2015). Analyzing the dimensions of the quality of life in hepatitis B patients using confirmatory factor analysis. Global Journal of Health Science,7(7), 22–31.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Woo, G., Tomlinson, G., Yim, C., Lilly, L., Therapondos, G., Wong, D. K., et al. (2012). Health state utilities and quality of life in patients with hepatitis B. Canadian Journal of Gastroenterology and Hepatology,26(7), 445–451.

    Google Scholar 

  11. Zhuang, G., Zhang, M., Liu, Y., Guo, Y., Wu, Q., Zhou, K., et al. (2014). Significant impairment of health-related quality of life in mainland Chinese patients with chronic hepatitis B: A cross-sectional survey with pair-matched healthy controls. Health and Quality of Life Outcomes,12, 101–109.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Boscarino, J. A., Lu, M., Moorman, A. C., Gordon, S. C., Rupp, L. B., Spradling, P. R., et al. (2015). Predictors of poor mental and physical health status among patients with chronic hepatitis C infection: The Chronic Hepatitis Cohort Study (CHeCS). Hepatology,61(3), 802–811.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Moorman, A. C., Gordon, S. C., Rupp, L. B., Spradling, P. R., Teshale, E. H., Lu, M., et al. (2013). Baseline characteristics and mortality among people in care for chronic viral hepatitis: The chronic hepatitis cohort study. Clinical Infectious Diseases,56(1), 40–50.

    Article  PubMed  Google Scholar 

  14. Spradling, P. R., Rupp, L., Moorman, A. C., Lu, M., Teshale, E. H., & Gordon, S. C., et al. (2012). Hepatitis B and C virus infection among 1.2 million persons with access to care: Factors associated with testing and infection prevalence. Clinical Infectious Diseases,55(8), 1047–1055.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Center for Diseases Control (CDC). (2013). Locations and reasons for initial testing for hepatitis C infection–chronic hepatitis cohort study, United States, 2006–2010. MMWR. Morbidity and Mortality Weekly Report,62(32), 645–648.

    Google Scholar 

  16. Ware, J. E., Jr., Kosinski, M., Bjorner, J. B., Bayliss, M. S., Batenhorst, A., Dahlof, C. G., et al. (2003). Applications of computerized adaptive testing (CAT) to the assessment of headache impact. Quality of Life Research,12(8), 935–952.

    Article  PubMed  Google Scholar 

  17. Turner-Bowker, D. M., Bayliss, M. S., Ware, J. E., Jr., & Kosinski, M. (2003). Usefulness of the SF-8 Health Survey for comparing the impact of migraine and other conditions. Quality of Life Research,12(8), 1003–1012.

    Article  PubMed  Google Scholar 

  18. Holmes, T. H., & Rahe, R. H. (1967). The social readjustment rating scale. Journal of Psychosomatic Research,11(2), 213–218.

    Article  CAS  PubMed  Google Scholar 

  19. Boscarino, J. A., & Adams, R. E. (2009). PTSD onset and course following the World Trade Center disaster: Findings and implications for future research. Social Psychiatry and Psychiatric Epidemiology,44(10), 887–898.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Boscarino, J. A., Hoffman, S. N., Adams, R. E., Figley, C. R., & Solhkhah, R. (2014). Mental health outcomes among vulnerable residents after Hurricane Sandy: Implications for disaster research and planning. American Journal of Disaster Medicine,9(2), 107–120.

    Article  PubMed  Google Scholar 

  21. Stewart, A. L., & Ware, J. E. (Eds.). (1992). Measuring functioning and well-being: The Medical Outcomes Study Approach. Durham, NC: Duke University Press.

    Google Scholar 

  22. Stewart, A. L., Greenfield, S., Hays, R. D., Wells, K., Rogers, W. H., & Berry, S. D., et al. (1989). Functional status and well-being of patients with chronic conditions. Results from the Medical Outcomes Study. JAMA,262(7), 907–913.

    Article  CAS  PubMed  Google Scholar 

  23. Stewart, A. L., Hays, R. D., & Ware, J. E. (1988). The MOS short-form general health survey. Reliability and validity in a patient population. Med Care,26(7), 724–735.

    Article  CAS  PubMed  Google Scholar 

  24. McDonald, S. D., Mickens, M. N., Goldberg-Looney, L. D., Mutchler, B. J., Ellwood, M. S., & Castillo, T. A. (2018). Mental disorder prevalence among U.S. Department of Veterans Affairs outpatients with spinal cord injuries. The Journal of Spinal Cord Medicine,41(6), 1–12.

    Article  Google Scholar 

  25. Ware, J. E., & GlaxoSmithKline, (Eds.). (2001). How to score and interpret single-item health status measures: A manual for users of the of the SF-8 health survey : (with a supplement on the SF-6 health survey). Boston, MA: Lincoln, RI : QualityMetric, Inc.; Boston. MA: Health Assessment Lab.

    Google Scholar 

  26. Ware, J. E., Kosinski, M., Turner-Bowker, D. M., & Gandek, B. (Eds.). (2001). How to score the SF-8 Health Survey. Boston, MA: Health Assessment Lab.

    Google Scholar 

  27. Bradley, K. A., Bush, K. R., McDonell, M. B., Malone, T., & Fihn, S. D. (1998). Screening for problem drinking: Comparison of CAGE and AUDIT. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. J Gen Intern Med,13(6), 379–388.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Bush, K., Kivlahan, D. R., McDonell, M. B., Fihn, S. D., & Bradley, K. A. (1998). The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Archives of Internal Medicine,158(16), 1789–1795.

    Article  CAS  PubMed  Google Scholar 

  29. Adams, R. E., Boscarino, J. A., & Galea, S. (2006). Social and psychological resources and health outcomes after the World Trade Center disaster. Social Science and Medicine,62(1), 176–188.

    Article  PubMed  Google Scholar 

  30. Freedy, J. R., Kilpatrick, D. G., & Resnick, H. S. (1993). Natural disasters and mental health: Theory, assessment, and intervention. Journal of Social Behavior and Personality,8(5), 49–103.

    Google Scholar 

  31. Sherbourne, C. D., & Stewart, A. L. (1991). The MOS social support survey. Social Science and Medicine,32(6), 705–714.

    Article  CAS  PubMed  Google Scholar 

  32. Galea, S., Ahern, J., Resnick, H., Kilpatrick, D., Bucuvalas, M., Gold, J., et al. (2002). Psychological sequelae of the September 11 terrorist attacks in New York City. New England Journal of Medicine,346(13), 982–987.

    Article  PubMed  Google Scholar 

  33. National Center for Health Statistics (2003). U.S. Census 2000 population with bridged categories. (Vol. (PHS) 2003–1335). Hyattsville, MD: U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics.

  34. Deyo, R. A., Cherkin, D. C., & Ciol, M. A. (1992). Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. Journal of Clinical Epidemiology,45(6), 613–619.

    Article  CAS  PubMed  Google Scholar 

  35. Austin, S. R., Wong, Y. N., Uzzo, R. G., Beck, J. R., & Egleston, B. L. (2013). Why summary comorbidity measures such as the charlson comorbidity index and elixhauser score work. Medical Care,53(9), e65–72.

    Article  Google Scholar 

  36. Scheffé, H. (1953). A method for judging all contrastsin the analysis of variance. Biometrika,40(1–2), 87–110.

    Google Scholar 

  37. Centers for Disease Control and Prevention. (2018). Current cigarette smoking among adults-United States, 2005–2016. Morbidity and Mortality Weekly Report,67(2), 53.

    Article  Google Scholar 

  38. National Institute on Alcohol Abuse and Alcoholism (2017). Alcohol Facts and Statistics. Accessed March, 2018.

  39. National Institute on Drug Abuse (2015). Nationwide Trends. Accessed March, 2018.

  40. Bosma, H., Peter, R., Siegrist, J., & Marmot, M. (1988). Two alternative job stress models and the risk of coronary heart disease. American Journal of Public Health,88(1), 68–74.

    Article  Google Scholar 

  41. Atesci, F. C., Cetin, B. C., Oguzhanoglu, N. K., Karadag, F., & Turgut, H. (2005). Psychiatric disorders and functioning in hepatitis B virus carriers. Psychosomatics,46(2), 142–147.

    Article  PubMed  Google Scholar 

  42. Adams, R. E., & Boscarino, J. A. (2011). A structural equation model of perievent panic and posttraumatic stress disorder after a community disaster. Journal of Traumatic Stress,24(1), 61–69.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Yamashita, J. (2012). A review of psychological assessments for disaster mental health studies. Psychological Trauma,4(6), 560–567.

    Article  Google Scholar 

  44. Slobodin, O., Caspi, Y., Klein, E., Berger, B. D., & Hobfoll, S. E. (2011). Resource loss and posttraumatic responses in Bedouin members of the Israeli Defense Forces. Journal of Traumatic Stress,24(1), 54–60.

    Article  PubMed  Google Scholar 

  45. Karacaer, Z., Cakir, B., Erdem, H., Ugurlu, K., Durmus, G., Ince, N. K., et al. (2016). Quality of life and related factors among chronic hepatitis B-infected patients: A multi-center study, Turkey. Health and Quality of Life Outcomes,14(1), 153–162.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Tutuncu, E. E., Guner, R., Gurbuz, Y., Kaya Kalem, A., Ozturk, B., Hasanoglu, I., et al. (2017). Adherence to nucleoside/nucleotide analogue treatment in patients with chronic hepatitis B. Balkan Medical Journal,34(6), 540–545.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Eisenberg, J. M., & Power, E. J. (2000). Transforming insurance coverage into quality health care: Voltage drops from potential to delivered quality. JAMA,284(16), 2100–2107.

    Article  CAS  PubMed  Google Scholar 

  48. Margaretten, M., Yelin, E., Imboden, J., Graf, J., Barton, J., Katz, P., et al. (2009). Predictors of depression in a multiethnic cohort of patients with rheumatoid arthritis. Arthritis and Rheumatism,61(11), 1586–1591.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Center for Behavioral Health Statistics and Quality (2015). 2014 National Survey on Drug Use and Health: Detailed Tables. Accessed June, 2019.

  50. Ozkan, M., Corapcioglu, A., Balcioglu, I., Ertekin, E., Khan, S., Ozdemir, S., et al. (2006). Psychiatric morbidity and its effect on the quality of life of patients with chronic hepatitis B and hepatitis C. International Journal of Psychiatry in Medicine,36(3), 283–297.

    Article  PubMed  Google Scholar 

  51. Arnsten, J., Demas, P., Grant, R., Gourevitch, M., Farzadegan, H., Howard, A., et al. (2002). Impact of active drug use on antiretroviral therapy adherence and viral suppression in HIV-infected drug users. JGIM,17(5), 377–381.

    Article  PubMed  Google Scholar 

  52. Coleman, K. J., Stewart, C., Waitzfelder, B. E., Zeber, J. E., Morales, L. S., Ahmed, A. T., et al. (2016). Racial-ethnic differences in psychiatric diagnoses and treatment across 11 health care systems in the mental health research network. Psychiatric Services (Washington, D. C.),67(7), 749–757.

    Article  Google Scholar 

  53. Center for Diseases Control (2016). Surveillance for Viral Hepatitis – United States, 2014. Accessed May, 2017.

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The CHeCS Investigators include the following investigators and sites: Scott D. Holmberg, Eyasu H. Teshale, Philip R. Spradling, Anne C. Moorman, Jian Xing, and Yuna Zhong, Division of Viral Hepatitis; National Centers for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia; Stuart C. Gordon, David R. Nerenz, Mei Lu, Lois Lamerato, Jia Li, Loralee B. Rupp, Nonna Akkerman, Nancy Oja-Tebbe, Talan Zhang, Sheri Trudeau, and Yueren Zhou, Henry Ford Health System, Detroit, Michigan; Joseph A. Boscarino, Zahra S. Daar, and Robert E. Smith, Department of Epidemiology and Health Services Research, Geisinger Clinic, Danville, Pennsylvania; Yihe G. Daida, Connie Mah Trinacty, Jonathan W. Lai, and Carmen P. Wong, Center for Integrated Health Care Research, Kaiser Permanente-Hawaii, Honolulu, Hawaii; Mark A. Schmidt and Judy L. Donald, The Center for Health Research, Kaiser Permanente-Northwest, Portland, OR.


The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.


This study was funded by the Centers for Disease Control and Prevention and from Gilead Sciences. CHeCS was previously funded through May 2016 by the CDC Foundation, which received grants from AbbVie; Genentech, A Member of the Roche Group; Gilead Sciences; Janssen Pharmaceuticals, Inc. and Vertex Pharmaceuticals; past partial funders include Bristol-Myers Squibb. Granting corporations do not have access to CHeCS data and do not contribute to data analysis or writing of manuscripts.

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Correspondence to Yihe G. Daida.

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Conflict of interest

Stuart C. Gordon receives grant/research support from AbbVie Pharmaceuticals, Conatus, CymaBay, Gilead Sciences, Intercept Pharmaceuticals, and Merck. He is also a consultant/advisor for Dova Pharmaceuticals and Intercept and serves as a speaker/teacher in programs sponsored by Dova. Mei Lu, Joseph A. Boscarino, Mark A. Schmidt, Yihe G. Daida, and Loralee B. Rupp receive research grant support from Gilead Sciences and Intercept Pharmaceuticals. Eyasu H. Teshale, Anne C. Moorman, and Philip R. Spradling have no conflicts of interest to report.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study protocol was reviewed and approved by an Institutional Review Board at each participating study site.

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The IRB has waived Informed Consent and Authorization for the use of electronic health records in this study. Passive informed consent was obtained from all individual participants who completed the study survey.

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for the Chronic Hepatitis Cohort Study Investigators are listed in “Acknowledgements”.

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Daida, Y.G., Boscarino, J.A., Moorman, A.C. et al. Mental and physical health status among chronic hepatitis B patients. Qual Life Res 29, 1567–1577 (2020).

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