In total, 24,871 participants from NHANES were included: 14,886 (1999-2004) and 9,985 (2005-2008). Of these individuals, 14.0% had CLD and 8.6% had diabetes. During the study period, HepA vaccination in CLD increased from 13.3% ± 1.0% to 20.0% ± 1.5%, HepB vaccination increased from 23.4% ± 1.2% to 32.1% ± 1.5%. Of subtypes of CLD, HepA vaccination rates increased only in nonalcoholic fatty liver disease (NAFLD), whereas HepB vaccination increased for patients with hepatitis C and nonalcoholic fatty liver disease. In the diabetic cohort, HepA

vaccination rates increased from 9.3% ± 1.1% to 15.4% ± 1.7% and HepB rates increased from 15.2% ± 1.5% to 22.4% ± Ixazomib datasheet 1.7%. All changes were similar to those observed in the general population. The quality measure (QM) for HepA in the general population decreased from 44.4% ± 1.2% in 1999-2004 to 41.7% ± 1.9% in 2005-2008, and similar changes were noted for all subcohorts. On the other hand, QM for HepB increased from 31.7% ± 0.9% to 40.7% ± 1.0% in the population, whereas no changes in QM were noted in any diagnostic cohort except for NAFLD. Conclusions: Although vaccination Roscovitine chemical structure rates in CLD and diabetic cohorts are increasing, they remain low. Given the public health implications of acute hepatitis A and hepatitis

B in patients with CLD, better implementation of the vaccination recommendations for these populations is warranted. (HEPATOLOGY

2011) The Centers for Disease Control and Prevention estimates that liver disease is currently the 12th leading cause of death in the United States.1 Liver-related mortality usually results from complications of chronic liver disease, including advanced cirrhosis and hepatocelllar carcinoma (HCC). Despite a recent decline in many other cancers, the incidence of HCC continues to increase, especially in men.2-4 Furthermore, chronic liver disease (CLD) and related complications are associated with increased mortality, severely impaired quality of life, and substantial selleck chemicals resource utilization.5-8 Despite a decline in the incidence of hepatitis C, other liver diseases, such as diabetes and obesity-related nonalcoholic fatty liver disease (NAFLD), are increasing.9-11 Increasing evidence suggests that patients with preexisting CLD are at risk for a severe liver disease after acute infection with hepatitis A and/or hepatitis B viruses.12-15 This superinfection in patients with preexisting CLD may have a rapidly progressive course, leading to liver failure and death.16, 17 Additionally, severe acute hepatitis B infection has also been reported in patients with type II diabetes (diabetes mellitus [DM]).18 Given the high prevalence of NAFLD in patients with DM, many diabetics may have underlying CLD related to NAFLD.