{
  "abstract": "Introduction Chronic hepatitis B (HBV) causes significant morbidity and mortality worldwide, predominantly through HBV-related end-stage liver disease (ESLD) and hepatocellular carcinoma (HCC) 1.The World Health Organization aims to reduce HBV incidence by 95% and HBV-related mortality by 65%, between 2015–20302. The National Strategic Group for Viral Hepatitis aims to support achievement of this elimination goal in England3. Birmingham is committed to the Fast-Track Cities Plus initiative: to eliminate HIV, HBV, hepatitis C and tuberculosis, by 20304.Data from 2017–2019 indicated Birmingham’s under-75 mortality rate from HBV-related ESLD/HCC was one of the highest in England.5 This enhanced surveillance project reviews HBV-related deaths among adults accessing care in Birmingham, to better understand preventable mortality.Methods Clinicians in Birmingham hospitals identified deaths of adults with HBV between January 2018 and December 2023. Cause of death was obtained from hospital records, or by linkage to Office for National Statistics data. Deaths were deemed HBV-related based on definition agreed among working group, following literature review. Demographics, mode of HBV acquisition, risk factors, comorbidities, data on clinical profile and care pathway were collected on HBV-related deaths.Results Nearly a third of deaths (n=70; 31%) among 225 patients with HBV known to Birmingham hospitals who died during the study period, were deemed potentially HBV-related; most common cause (n=32) was HCC/liver cancer, and second-most common cause (n=17) was ESLD. Among these 70, 84% (n=59) were male, and median age at death was 61.5 years (IQR 47.5–68 years). Eighty percent (n=44) of those for whom country of birth was known, were born outside the UK, most in countries of intermediate-high HBV prevalence. Two-thirds (n=46) most likely acquired HBV in early life; yet median age at diagnosis in the UK was 53 years (IQR 43.5–61.5 years). Of patients with available testing records, 88% (n=37) were first diagnosed with HBV in secondary care. Of patients for whom liver disease stage was assessed at diagnosis, 79% (n=46) had cirrhosis.Conclusion In this cohort of 70 patients known to Birmingham hospitals dying of HBV-related causes, there were likely missed opportunities for earlier diagnosis, particularly in primary care. The majority were migrants and likely acquired HBV in early life. However, most patients were first diagnosed with HBV in secondary care, when middle-aged, already with advanced disease. Analysis is ongoing, and recommendations will be developed to improve care for people with HBV, prevent widening of health inequalities for at-risk populations, and reduce progression to mortality.References Sheena B, et al. Global, regional, and national burden of hepatitis B, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet Gastroenterology & Hepatology 2019;7(9):796 – 829World Health Organisation (2023). Hepatitis. Available at: Elimination of hepatitis by 2030.UK Health Security Agency (2023). Terms of reference of the National Strategic Group for Viral Hepatitis (NSGVH). Available at: Terms of reference of the National Strategic Group for Viral Hepatitis (NSGVH).Birmingham City Council (2024). Fast-track Cities Plus overview. Available at: Fast-Track Cities Plus overview | Fast-Track Cities Plus initiative | Birmingham City Council.Office for Health Improvement and Disparities (2025). Public Health Profiles. Available at: Fingertips | Department of Health and Social Care.",
  "authors": [
    {
      "affiliations": [
        "UK Health Security Agency West Midlands Health Protection Team, Birmingham,UK",
        "Birmingham City Council Public Health, Birmingham, UK"
      ],
      "name": "Sandhya Santharam"
    },
    {
      "affiliations": [
        "UK Health Security Agency West Midlands Health Protection Team, Birmingham,UK"
      ],
      "name": "Sara Croxford"
    },
    {
      "affiliations": [
        "University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"
      ],
      "name": "David Mutimer"
    },
    {
      "affiliations": [
        "University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK",
        "UK Health Security Agency Birmingham Laboratories, Birmingham, UK"
      ],
      "name": "Sowsan Atabani"
    },
    {
      "affiliations": [
        "UK Health Security Agency West Midlands Health Protection Team, Birmingham,UK"
      ],
      "name": "Srilaxmi Degala"
    },
    {
      "affiliations": [
        "University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"
      ],
      "name": "Ahmed Elsharkawy"
    },
    {
      "affiliations": [
        "University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"
      ],
      "name": "Faisal Khan"
    },
    {
      "affiliations": [
        "Birmingham City Council Public Health, Birmingham, UK"
      ],
      "name": "Keiran Mckenzie"
    },
    {
      "affiliations": [
        "University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"
      ],
      "name": "Alice Parsloe"
    },
    {
      "affiliations": [
        "Birmingham City Council Public Health, Birmingham, UK"
      ],
      "name": "Becky Pollard"
    },
    {
      "affiliations": [
        "Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK"
      ],
      "name": "Saket Singhal"
    },
    {
      "affiliations": [
        "University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"
      ],
      "name": "Steve Taylor"
    },
    {
      "affiliations": [
        "UK Health Security Agency West Midlands Health Protection Team, Birmingham,UK"
      ],
      "name": "Mamoona Tahir"
    }
  ],
  "title": "P114 Review of hepatitis B-related mortality in Birmingham, UK",
  "uid": "cd7bcf13-1758-51a1-a42d-9aaabd0822f0"
}