Are there differences in hepatitis-B immunization status between diabetes and non-diabetes subjects in Korea?

Ji Young Park; Su Kyoung Kwon

doi:10.7180/kmj.2018.33.1.41

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Original Article Are there differences in hepatitis-B immunization status between diabetes and non-diabetes subjects in Korea?: Ji Young Park¹, Su Kyoung Kwon²; Kosin Medical Journal 2018;33(1):41-50.
DOI: https://doi.org/10.7180/kmj.2018.33.1.41
Published online: January 21, 2018

¹Department of Internal Medicine, Division of Infection, College of Medicine, Kosin University, Busan, Korea

²Department of Internal Medicine, Division of Endocrinology and Metabolism, College of Medicine, Kosin University, Busan, Korea

Corresponding Author: Su Kyoung Kwon, Department of Internal Medicine, College of Medicine, Kosin University, 262, Gamchen-ro, Seo-gu, Busan 49267, Korea Tel: +82-51-990-6712 Fax: +82-51-990-6712 E-mail: mir316@naver.com

• Received: October 21, 2016 • Accepted: December 26, 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
References

Abstract

Objectives
The American Diabetes Association (ADA) recommends hepatitis-B virusVIruS vaccination for unvaccinated adults with diabetes. However, the Korean Diabetes Association (KDA) did not recommend hepatitis-B vaccination for unvaccinated adults with diabetes. This study was performed to assess the differences in hepatitis-B virus antigen and antibody status between Korean patients with diabetes and those without by using national survey data.
Methods
We analyzed hepatitis-B virus antigen and antibody status in 9,771 South Korean people from the general population based on the Korean National Health and Nutrition Examination Survey. Diabetes patients were defined as those with a measured fasting plasma glucose over 126 mg/dL or those who had been previously diagnosed with diabetes by other health care centers.
Results
Subjects with diabetes accounted for 812 (8.3%) among the 9771 study subjects. The prevalence ofhepatitis-B (HBsAg) seropositive subjects was not significantly different (3.9% vs. 4.6%, P = 0.09) between subjects with diabetes and those without. The prevalence of hepatitis-B antibody (HBsAb) positive subjects and unimmunized subjects was not significantly different (55.2% vs. 58.2%, P = 0.09, 40.9% vs. 37.2%, P = 0.09) between the two groups. The prevalence of unimmunized subjects decreased by age (< 20 years 33.3 % vs. 33.0%, 20~29 years 49.1% vs. 41.2%, 30~39 years 41.9% vs. 37.7%, 40~49 years 35.1% vs. 33.5%, 50~59 years 39.0% vs. 38.0%, 60~69 years 41.2% vs. 39.8%, > 70 years 48.5% vs. 42.8%) but was not significantly different between the 2 groups.
Conclusions
From this study, we conclude that there are not sufficient grounds to recommend routine hepatitis-B virus vaccination for unvaccinated Korean subjects with diabetes at this point in time in Korea. Further prospective studies will be needed.
Keywords: Diabetes; Hepatitis B; Immunization; Korean National Health and Nutrition

Fig. 1.

Distribution of hepatitis-B immunization status among diabetes and non-diabetes subjects.

Table 1.

Baseline characteristics of study subjects

Variables	Diabetes (n = 812)	Non diabetes (n = 8959)	P-value
Male : Female	415:397	4095:4864	0.021
Age, years	51.66 ± 15.67	37.91 ± 18.07	< 0.001
Weight, Kg	62.07 ± 10.81	58.8 ± 11.34	< 0.001
BMI, kg/m2	24.02 ± 3.41	22.47 ± 3.38	< 0.001
Waistcircumference(WC)	84.87 ± 9.34	77.75 ± 10.14	< 0.001
SBP, mmHg	134 ± 20.76	122.74 ± 18.75	< 0.001
DBP, mmHg	80.75 ± 12.44	75.99 ± 12.53	< 0.001
Pulserate, bpm	76.13 ± 10.88	74.02 ± 10.40	< 0.001
AST, U/L	51.66 ± 15.67	26.91 ± 18.52	< 0.001
ALT, U/L	33.84 ± 29.725	25.59 ± 21.30	< 0.001
Fastingbloodglucose, mg/dL	163.25 ± 62.04	93.65 ± 12.82	< 0.001
WBC, × 103/μL	6.15 ± 1.83	6.20 ± 18.28	0.947

Data are presented by mean ± standard deviation.

N, number; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; bpm, beats per minuite; AST, aspartate aminotransferase; ALT, alanine aminotransferase; WBC, white blood cell.

Table 2.

Age and Obesity adjusted means of liver function

Variables	Diabetes (n = 812)	Non diabetes (n = 8959)	P-value
Aspartate aminotransferase, AST, SGOT*	30.71 ± 0.69	27.07 ± 0.21	< 0.001
Alanine aminotransferase, ALT, SGPT*	31.35 ± 0.75	25.83 ± 0.23	< 0.001
AST**	30.12 ± 0.69	27.13 ± 0.21	< 0.001
ALT**	30.17 ± 0.75	25.95 ± 0.23	< 0.001

Data are presented by mean ± standard error

^* Adujusted by age and body mass index.

^** Adjusted by age, body mass index and waist circumference.

Table 3.

Distribution of hepatitis-B immunization status according to different age groups by diabetes status

Age Groups	Non-diabetes			Diabetes			P-value
Age Groups	HBV carrier	Immunized	Non-immunized	HBV carrier	Immunized	Non-immunized	P-value
Total(%)	408 (4.6%)	5189(58.2%)	3313 (37.2%)	36 (3.9%)	477 (55.2%)	348 (40.9%)	0.169
<20	42 (2.4%)	1152 (64.6%)	588 (33.0%)	1 (3.7%)	17 (63%)	9 (33.3%)	0.898
20-30	81 (5.6%)	764 (53.1%)	593 (41.2%)	0 (0.0%)	28 (50.9%)	27 (49.1%)	0.140
30-40	115 (6.2%)	1033 (56.0%)	696 (37.7%)	8 (6.5%)	64 (51.6%)	52 (41.9%)	0.622
40-50	77 (5.1%)	918 (61.4%)	501 (33.5%)	5 (3.7%)	82 (61.2%)	47 (35.1%)	0.747
50-60	63 (6.0%)	588 (56.0%)	396 (38.0%)	6 (2.9%)	122 (58.1%)	82 (39.0%)	0.188
60-70	21 (2.5%)	486 (57.7%)	335 (39.8%)	10 (6.1%)	87 (52.7%)	68 (41.2%)	0.078
70-80	10 (2.5%)	218 (54.1%)	175 (43.4%)	1 (1.1%)	45 (51.1%)	42 (47.7%)	0.605
≥ 80	3 (3.2%)	54 (57.4%)	37 (39.4%)	1 (5.3%)	8 (42.1%)	10 (52.6%)	0.463

HBV, hepatitis B virus; Immunozed, HBsAg (-) and HBsAb (+); Non-immunized, HBsAg (-) and HBsAb (-)

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