Acute hepatitis B in Japan: Incidence, clinical practices and health policy.
OBJECTIVE
The epidemiology of acute hepatitis B is unknown in many countries, and the clinical features of this disease remain unclear. In this study, we used the Diagnosis Procedure Combination (DPC) database to estimate the incidence of acute hepatitis B and investigate the clinical practices for acute hepatitis B in Japan.


METHODS
The DPC database is a nationwide discharge abstract and administrative claims database, covering 40% of all inpatient admissions to acute care hospitals between 1 July and 31 December each year in Japan. We identified cases with a diagnosis of acute hepatitis B between 2007 and 2008. Patient characteristics, length of stay, in-hospital mortality and total charges were determined. Clinical practice patterns were examined, including drugs used and procedures performed during hospitalization.


RESULTS
We identified 890 cases with acute hepatitis B among 5.85 million inpatients in the database. The mean age was 40.0 years old and 76% were male. The incidence of acute hepatitis B was estimated to be approximately 2100-2400/year (17-19/1 million people per year). Of 890 cases, 53 (6.0%) developed fulminant hepatitis and 36 (4.0%) died. Nucleos(t)ide analogs were prescribed for 226 cases (25.4%). Only 194 cases (21.8%) were tested for HIV status.


CONCLUSIONS
It is essential to monitor the trends of this communicable and preventable disease. The establishment and distribution of appropriate clinical evidence and guidelines are vital to improve the clinical practices for acute hepatitis B.
Department of Gastroenterology, National Center for Global Health and Medicine Department of Health Management and Policy, Graduate School of Medicine Department of Health Economics and Epidemiology Research, School of Public Health, University of Tokyo, Tokyo Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Fukuoka, Japan.
Akahito
A
Sako
Hideo
H
Yasunaga
Hiromasa
H
Horiguchi
Hideki
H
Hashimoto
Naohiko
N
Masaki
Shinya
S
Matsuda