A Systematic Review and Narrative Synthesis of Factors Impacting Late Diagnosis of Chronic Hepatitis B and C

ABSTRACT Background and Aims Late diagnosis of chronic hepatitis B and C, often identified by the presence of advanced disease such as hepatocellular carcinoma or decompensated cirrhosis at the time of initial hepatitis diagnosis, is associated with high rates of hospitalization and mortality. This review aimed to synthesize published evidence regarding factors associated with late diagnosis of viral hepatitis. Methods This review was conducted in accordance with the PRISMA guidelines. We conducted a search of four biomedical databases up to January 2025. Eligible studies included articles that explored factors associated with the late diagnosis of chronic hepatitis B and C. Due to heterogeneity across the studies, we conducted a narrative synthesis to summarise the identified barriers and facilitators. Results Of 5131 studies, 22 were eligible, with most from the USA (27%) and Australia (14%). The proportion of late diagnosis ranged from 11% to 70% (hepatitis C) and 15% to 51% (hepatitis B). Key barriers included older age, being male, history of alcohol misuse, HCV/diabetes comorbidity, and fewer physician visits; and facilitators were being female, history of injection drug use, higher number of physician visits and HCV/HIV comorbidity. Conclusions To promote the early detection of viral hepatitis, interventions targeting men, older individuals, diabetic patients and those with a background of alcohol abuse are required. Undiagnosed individuals should be sought out and linked to treatment programs.