Hepatitis B and C in Taiwanese patients with Schizophrenia: A Nationwide, Population-based study on prevalence, and healthcare utilization

Introduction: Hepatic viral infections (hepatitis B virus (HBV) and hepatitis C virus (HCV)) are endemic in Taiwan, and can progress to liver cirrhosis and hepatocellular carcinoma. Schizophrenia patients present substantial undiagnosed and untreated comorbidities compared with the general population. Hence, the prevalence of comorbid HBV/HCV infections in, and healthcare utilization by patients with schizophrenia should be determined. Methods: This cross-sectional analysis of 5-year data from the Taiwan National Health Insurance administrative health insurance database evaluated the prevalence and relative risk (RR) of comorbid HBV/HCV infections in schizophrenia patients (n=155,783) versus non-schizophrenia controls (n=467,349). Healthcare utilization was assessed using a two-part logistic regression and linear regression model. Results: Schizophrenia patients had a greater prevalence of comorbid HBV/HCV infections than non-schizophrenia controls (HBV: 3.5% vs. 2.5%, RR=1.51, 95% confidence interval [CI]: 1.43–1.60, p<0.0001; HCV: 1.9% vs. 0.9%, RR=2.1, 95% CI: 1.86–2.38, p<0.0001). Subgroup analysis showed a decreased risk of comorbid HBV or HCV infections in schizophrenia patients with increasing age. Significantly fewer schizophrenia patients underwent antiviral monitoring (alpha-fetoprotein checkup: 78.8% vs. 86.9% for HBV; 80.2% vs. 88.2% for HCV; p<0.0001), and received fewer antiviral medications (oral antiviral therapy for HBV: 6.9% vs. 10.3%; interferon-alpha therapy for HCV: 7.2% vs. 16.6%, p<0.0001) than non-schizophrenia controls. Discussion: In Taiwan, schizophrenia patients are significantly more susceptible to comorbid viral infections versus the general population. This study reinforces the urgency of timely diagnosis and interventional treatment in this underserved population.