title: Surveillance rates for hepatocellular carcinoma among patients with cirrhosis, chronic hepatitis B, and chronic hepatitis C based on Japanese claims database.
abstract: OBJECTIVE
  Surveillance is recommended for patients with risk of hepatocellular carcinoma (HCC) such as viral hepatitis and liver cirrhosis (LC). Although populations are at higher risk in Asia, surveillance rates have not been evaluated in those countries. Therefore, we aimed to examine surveillance rates for HCC and to compare predictors for surveillance among each type of liver disease in Japan.
  
  
  METHODS
  We carried out an observational study using the medical claims data of Japan. A total of 4713 patients who were diagnosed with LC, hepatitis B virus (HBV), or hepatitis C virus (HCV) infection were followed for 12 months. We described surveillance rates in patients with HBV or HCV infection or non-viral LC and evaluated potential predictors for follow-up surveillance among them by using multivariable logistic regression analysis, in which we set explanatory variables as sex, age, medical facility, HBV or HCV infection, and LC.
  
  
  RESULTS
  The HCC surveillance rate during follow-up was 42.3% among patients with chronic viral hepatitis, 56.5% with viral cirrhosis and 26.0%, with non-viral LC. Significant predictors for follow-up surveillance were presence of LC and hospital visits. Hepatitis B virus-infected patients aged <50 years and HCV-infected patients aged ≥50 years were more likely to undergo exams, that is, different tendencies between HBV and HCV patients were shown.
  
  
  CONCLUSIONS
  Follow-up surveillance for HCC was not adequately carried out among patients at risk for HCC in Japan, despite of recommendation in guidelines. In future, methodological research might be needed to increase surveillance rates for HCC in patients with chronic hepatitis or those who received treatment at a clinic.
authors.affiliation: Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan.|Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan.
authors.forename: Aya
authors.initials: A
authors.lastname: Hirata
authors.affiliation: Center for Supercentenarian Medical Research, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Hirata
authors.affiliation: Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan.
authors.forename: Yoshimitsu
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan.
authors.forename: Takeo
authors.initials: T
authors.lastname: Nakayama
keywords: Japan; hepatocellular carcinoma; medical claims data; practice guidelines; surveillance