Prevalence of chronic hepatitis B among foreign-born persons living in the United States by country of origin

Center for Liver Disease, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA.
Hepatology (Impact Factor: 11.06). 08/2012; 56(2):422-33. DOI: 10.1002/hep.24804
Source: PubMed


Estimates of the prevalence of chronic hepatitis B (CHB) in the United States differ significantly, and the contribution of foreign-born (FB) persons has not been adequately described. The aim of this study was to estimate the number of FB persons in the United States living with CHB by their country of origin. We performed a systematic review for reports of HBsAg seroprevalence rates in 102 countries (covering PubMed from 1980 to July 2010). Data from 1,373 articles meeting inclusion criteria were extracted into country-specific databases. We identified 256 seroprevalence surveys in emigrants from 52 countries (including 689,078 persons) and 1,797 surveys in the general populations of 98 countries (including 17,861,035 persons). Surveys including individuals with lower or higher risk of CHB than the general population were excluded. Data were combined using meta-analytic methods to determine country-specific pooled CHB prevalence rates. Rates were multiplied by the number of FB living in the United States in 2009 by country of birth from the U.S. Census Bureau to yield the number of FB with CHB from each country. We estimate a total of 1.32 million (95% confidence interval: 1.04-1.61) FB in the United States living with CHB in 2009; 58% migrated from Asia and 11% migrated from Africa, where hepatitis B is highly endemic. Approximately 7% migrated from Central America, a region with lower CHB rates, but many more emigrants to the United States. This analysis suggests that the number of FB persons living with CHB in the United States may be significantly greater than previously reported. Assuming 300,000-600,000 U.S.-born persons with CHB, the total prevalence of CHB in the United States may be as high as 2.2 million.

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    • "This may have been because this estimate was based on a strict definition of CHB infection that required two diagnoses recorded more than 6 months apart. A second reason for this finding might be because of the fact that persons who make up the highest CHB risk groups (e.g., Asians and foreign-born persons) are less commonly enrolled in Medicaid [12] [13]. Alternatively, the low prevalence of CHB might be due to underdiagnosis of CHB infection among Medicaid enrollees. "
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    ABSTRACT: Purpose Few population-based studies have estimated the number of persons diagnosed with chronic hepatitis B (CHB) infection in the United States. Our objective was to estimate the prevalence of diagnosed CHB infection among persons enrolled in the U.S. Medicaid programs of California, Florida, New York, Ohio, and Pennsylvania between 2000 and 2007. As part of our analyses, we confirmed the accuracy of CHB diagnoses within the Medicaid database. Methods CHB infection was defined by the presence of two outpatient CHB diagnoses recorded more than 6 months apart. Two clinicians reviewed the medical records of a random sample of patients who met this definition to confirm the diagnosis, which enabled calculation of the positive predictive value (PPV). The period prevalence of diagnosed CHB infection among Medicaid enrollees with at least 6 months of membership from 2000-2007 was then estimated, adjusting for both the PPV and estimated sensitivity of our definition of CHB infection. Results The definition of CHB infection accurately identified clinician-confirmed cases (PPV, 96.3%; 95% confidence interval [CI], 87.3-99.5). Using this definition, 31,046 cases of CHB were diagnosed among 31,358,010 eligible Medicaid members from the five states (prevalence, 9.9 [95% CI, 9.8-10.0] per 10,000). Adjusting for the PPV and estimated sensitivity of our CHB definition, the prevalence of diagnosed CHB infection was 15.6 (95% CI, 15.4-15.7) per 10,000. Conclusions Two outpatient CHB diagnoses recorded more than 6 months apart validly identified clinician-confirmed CHB. The prevalence of diagnosed CHB infection among U.S. Medicaid enrollees was 15.6 per 10,000.
    Annals of epidemiology 06/2014; 24(6). DOI:10.1016/j.annepidem.2014.02.013 · 2.00 Impact Factor
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    • "In the U.S. the CDC estimates two-thirds of those chronically infected with HBV are foreign-born and about half are of Asian descent [12]. Accordingly, current AASLD guidelines recommend HBV screening for Asians, yet recent survey data [13-15] shows among insured Asian-American patients only about half are tested. "
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    ABSTRACT: Background Hepatitis B virus (HBV) infection is prevalent in Asian immigrants in the USA. California’s Inland Empire region has a population of approximately four million, including an estimated 19,000 first generation Koreans. Our aim was to screen these adult individuals to establish HBV serological diagnoses, educate, and establish linkage to care. Methods A community-based program was conducted in Korean churches from 11/2009 to 2/2010. Subjects were asked to complete a HBV background related questionnaire, provided with HBV education, and tested for serum HBsAg, HBsAb and HBcAb. HBsAg positive subjects were tested for HBV quantitative DNA, HBeAg and HBeAb, counseled and directed to healthcare providers. Subjects unexposed to HBV were invited to attend a HBV vaccination clinic. Results A total of 973 first generation Koreans were screened, aged 52.3y (18-93y), M/F: 384/589. Most (75%) had a higher than high school education and were from Seoul (62.2%). By questionnaire, 24.7% stated they had been vaccinated against HBV. The serological diagnoses were: HBV infected (3.0%), immune due to natural infection (35.7%), susceptible (20.1%), immune due to vaccination (40.3%), and other (0.9%). Men had a higher infection prevalence (4.9% vs. 1.7%, p = 0.004) and a lower vaccination rate (34.6% vs. 44.0%, p = 0.004) compared to women. Self-reports of immunization status were incorrect for 35.1% of subjects. Conclusions This large screening study in first generation Koreans in Southern California demonstrates: 1) a lower than expected HBV prevalence (3%), 2) a continued need for vaccination, and 3) a need for screening despite a reported history of vaccination.
    BMC Infectious Diseases 05/2014; 14(1):269. DOI:10.1186/1471-2334-14-269 · 2.61 Impact Factor
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    • "Chronic hepatitis B (CHB) remains a significant global health burden, despite widespread hepatitis B virus (HBV) vaccination programs. In the US, estimates suggest that more than 2 million people are living with CHB1,2 and that the clinical sequelae of untreated CHB, such as cirrhosis, hepatic decompensation, and hepatocellular carcinoma (HCC), contribute to up to 4,000 deaths per year.1,2 Effective antiviral therapy can reduce progression to cirrhosis and minimize the risk of HCC;3–5 however, in the US, HBV antiviral treatment is prescribed to fewer than 50,000 people per year.6 "
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    ABSTRACT: In the US, over 1 million Asian Americans are estimated to be living with chronic hepatitis B (CHB). Research has shown low awareness of CHB and different attitudes towards its treatment among the diverse ethnicities of Asian Americans. This study aimed to understand the perceptions and attitudes of CHB treatment among Asian Americans diagnosed with CHB who were either treatment-naïve or being treated for CHB with oral antivirals, and to understand the relative importance of different clinical and economic attributes of oral antivirals that affect CHB treatment decisions and choices. Face-to-face structured survey administered to participants at central research facilities by interviewers of each participating ethnicity. CHB patients from Chinese, Korean, and Vietnamese communities of New York metropolitan, San Francisco/Bay, and Los Angeles/Orange County areas. A 'conjoint' exercise (discrete choice model) assessed the relative impact of treatment attributes on treatment choice. Implicit "trade-off" decisions made by respondents were estimated using a hierarchical Bayesian model. Among 252 participants, 36 % were Chinese, 34 % Vietnamese, and 31 % Korean; 56 % were treatment-naïve and 44 % were being treated with an oral antiviral for CHB. The majority (88 %) believed that, if left untreated, CHB can lead to serious liver damage; 72 % believed there are effective prescription medications to treat CHB; and 39 % showed reluctance to be on long-term therapy for CHB because of concerns over side effects. Long-term risk of kidney damage was given the highest relative importance (38 %) when choosing CHB treatment, followed by medication cost (23.4 %), long-term risk of bone thinning (18 %), long-term efficacy (9 %), time on US market (6.8 %), and number of patients treated globally (4.9 %). Results were consistent across ethnicities. Patients need access to improved education regarding CHB disease progression, its management, disease outcomes, and the importance of long-term treatment of the disease.
    Journal of General Internal Medicine 12/2013; 29(3). DOI:10.1007/s11606-013-2673-0 · 3.42 Impact Factor
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