Alcohol and tobacco use are infrequent in North American adults with chronic hepatitis B (HBV): Results from the NIDDK-Sponsored Hepatitis B Research Network (HBRN) Adult Cohort Study

Abstract

Background: There is limited information on alcohol and tobacco consumption in adults with chronic HBV, even though these are important risk factors for hepatocellular carcinoma in this patient population. We aimed to evaluate the prevalence and characteristics of alcohol and tobacco use within the ongoing multicenter HBRN Adult Cohort Study. Methods: As of March 2013, 1545 adults with chronic HBV had self-reported data on use of tobacco products categorized as never used, former smoker, or current smoker; and alcohol consumption categorized as none in the last 12 months, moderate, or at risk consumption (males >4 drinks/day or 14 drinks/week, females >3 drinks/day or 7 drinks/week or history of binge drinking). Estimates of tobacco and alcohol use (N per 100) were calculated for the overall sample, and separately by demographic and clinical variables. Results: 51% were male, age range 18- 80 years, 72% Asian, and 60% acquired HBV vertically. Overall estimates of current tobacco use were 9.8 (per 100, 95%CI 8.2-11.5), with former tobacco use in 19.4 (per 100, 95%CI 16.9-21.8). Current (14.7 male, 4.5 female per 100) or former (27.6 male, 10.4 female per 100) tobacco use was more common in men (p<0.001), and differed by age (p=0.047), with the most differences seen for former use (12.3 in age <30 years, 19.6 in 30-<50 years, and 22.9 in >50 years per 100). Whites had a higher rate of current (17.7/100) or former (29.0/100) tobacco use compared to blacks (10.7/100, 17.8/100) or Asians (8.4/100, 17.9/100). Current tobacco use was highest in those with income <$50,000 (13.7/100). The overall rates of at-risk and moderate alcohol intake within the past 12 months were 4.8 (95%CI 3.6-6.1 per 100), and 21.5 (95%CI 19.1-23.9 per 100), respectively. Alcohol use differed by sex for both at-risk (6.2/100 male, 3.3/100 female) and moderate (25.5/100 male, 17.2/100 female) drinking (p<0.001). Asians had the lowest (3.6/100) and whites had the highest (12.5/100) at-risk drinking. Both at-risk and moderate drinking rates were lowest in those >50 years old (3.1 and 16.9 per 100, respectively), and differed by income, with the highest at-risk drinking (8.5/100) for income $50,000- 99,000. Neither tobacco nor alcohol use were associated with measures of disease activity, including ALT level, HBV DNA level or fibrosis by APRI score. Conclusions: Alcohol and tobacco use in adults with chronic HBV were lower than the general US population. White men had the highest alcohol and tobacco use. Impact of these parameters on disease progression will be prospectively tracked in this ongoing cohort study. The need of alcohol and smoking cessation education program remains.