Population-based study of autoimmune hepatitis and primary biliary cholangitis in Germany: rising prevalences based on ICD codes, yet deficits in medical treatment

Marcial Sebode; Angela Kloppenburg; Annette Aigner; Ansgar W. Lohse; Christoph Schramm; Roland Linder

doi:10.1055/a-1135-9306

Zeitschrift für Gastroenterologie, Table of Contents

Z Gastroenterol 2020; 58(05): 431-438
DOI: 10.1055/a-1135-9306

Originalarbeit

Population-based study of autoimmune hepatitis and primary biliary cholangitis in Germany: rising prevalences based on ICD codes, yet deficits in medical treatment

Populationsbasierte Analyse von autoimmuner Hepatitis und primär biliärer Cholangitis in Deutschland: ansteigende Prävalenzen basierend auf ICD Codes, aber Defizite bei der medikamentösen Therapie

Marcial Sebode

¹I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

²European Reference Network on Rare Hepatological Diseases (ERN RARE-LIVER).

,

Angela Kloppenburg

³Techniker Krankenkasse, Hamburg, Germany

,

Annette Aigner

⁴Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

⁵Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Berlin, Germany

,

Ansgar W. Lohse

¹I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

²European Reference Network on Rare Hepatological Diseases (ERN RARE-LIVER).

,

Christoph Schramm^*

¹I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

²European Reference Network on Rare Hepatological Diseases (ERN RARE-LIVER).

⁶Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

,

Roland Linder^*

³Techniker Krankenkasse, Hamburg, Germany

› Author Affiliations

Abstract

Background Population-based data on the prevalence of and real-life treatment for the autoimmune liver diseases (AILD), primary biliary cholangitis (PBC) and autoimmune hepatitis (AIH), are scarce, and such knowledge may help to improve patient care.

Methods Data of 8.1 million individuals having health insurance with the “Techniker Krankenkasse,” the largest German health insurer, were analyzed with regard to the prevalence of and prescribed medication for AILD in Germany from 2011 until 2014. Patients with viral hepatitis B infection (HBV) and alcoholic liver cirrhosis (ALC) served as control groups. Case definition was based on ICD codes.

Results The prevalences of PBC and AIH were 36.9/100 000 inhabitants (95 % CI: 35.6–38.2) and 23.0/100 000 inhabitants (95 % CI: 22.0–24.0) in 2014, respectively. The prevalences of AILD increased from 2011 to 2014 (for PBC by 31 % and for AIH by 29 %), with the largest increase for male patients with PBC. In contrast, the prevalence of HBV declined while that of ALC remained stable. The analysis of prescribed real-life treatment revealed considerable deviations from standard treatment recommendations. Specifically, in older patients with PBC or AIH, undertreatment was common.

Conclusion The prevalence of PBC and AIH based on ICD codes is increasing in Germany. The analysis of real-life treatment in this large and population-based cohort points to the unmet need to improve the implementation of treatment guidelines for autoimmune liver diseases in the broader medical community.

Zusammenfassung

Hintergrund Es gibt nur wenige populationsbasierte Studien zur Prävalenz und zur „Real-Life“-Therapie der autoimmunen Lebererkrankungen Primär Biliäre Cholangitis (PBC) und Autoimmune Hepatitis (AIH).

Methoden Es wurden 8,1 Millionen Versichertendaten der Techniker Krankenkasse analysiert bezüglich der Prävalenz und rezeptierten Medikation von Patienten mit autoimmunen Lebererkrankungen in Deutschland von 2011 bis 2014. Patienten mit einer Virushepatitis-B-Infektion (HBV) und mit alkoholischer Leberzirrhose (C2 LZX) dienten als Kontrollgruppen. Die Patienten wurden anhand von ICD-Codes identifiziert.

Ergebnisse Die PBC und die AIH weisen in Deutschland im Jahr 2014 eine Prävalenz von 36,9 pro 100 000 Einwohner (95 %-KI: 35,6–38,2) beziehungsweise 23,0 pro 100 000 Einwohner (95 %-KI: 22,0–24,0) auf. Die Prävalenz autoimmuner Lebererkrankungen stieg von 2011 bis 2014 an (für die PBC um 31 % und für die AIH um 29 %), wobei männliche PBC-Patienten den stärksten Anstieg aufwiesen. Die Prävalenz von HBV und C2 LZX nahm ab beziehungsweise blieb stabil. Eine Analyse der „Real-Life“-Therapie der autoimmunen Lebererkrankungen ergab erhebliche Abweichungen von Therapieleitlinien; insbesondere bei älteren AIH- und PBC-Patienten lag eine Untertherapie vor.

Schlussfolgerung Die Prävalenz der PBC und AIH basierend auf ICD-Codes steigt in Deutschland an. Die populationsbasierte Analyse der „Real-Life“-Therapie autoimmuner Lebererkrankungen in Deutschland weist auf Defizite in der breiten medizinischen Versorgung hinsichtlich der Umsetzung von Therapieleitlinien hin.

Key words

autoimmune hepatitis - primary biliary cholangitis - Germany - treatment - prevalence

Schlüsselwörter

autoimmune Jepatitis - Primär Biliäre Cholangitis - Deutschland - Therapie - Prävalenz

Full Text

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