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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    • "In addition, there are 8000 migrants from Micronesia/Marshall Islands currently living in Hawaii, as they are able to travel without the need for visas [8]. The incidence of HBV in these small Pacific Island nations is reportedly as high as 15% [9]. As a consequence, Hawaii has the highest incidence and second highest death rate of hepatocellular cancer in the U.S. and nearly 40% of this is HBV-related [10] [11]. "
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    ABSTRACT: Purpose: Hawaii had the highest incidence of liver cancer in the US and had a unique patient population with many immigrants from the Pacific and Asia where Hepatitis B virus (HBV) was en-demic. HBV screening in high risk populations was a recommended measure of preventative medicine , thus we sought to examine physician screening patterns for HBV in Hawaii. Methods: We retrospectively analyzed billing claims from 1999 to 2009 from the largest healthcare coverage provider in the state of Hawaii. We identified all patients (>18 years) who underwent HBV screening based on Current Procedural Terminology (CPT) billing codes. We collected data on age, gender and specialty of physicians ordering the screening tests. Analysis was done in 2013 and 2014. Results: Of an estimated 700,000 covered lives, 125,576 patients underwent HBV screening. We stratified the patients into two eras from 1999-2004 (N = 52,245) and 2005-2009 (N = 73,331) to examine temporal trends. In the first era, 30,975 women (59.3%) underwent HBV screening, compared to 49,950 women (69.1%) screened in the 2005-2009 era. There absolute number of tests increased, but the proportion done by primary care MDs decreased from 55.6% to 44.9%. OB/GYN screened 15.6% in the early era and 26.9% in later era. Conclusions: There was an increase in women aged 18-40 years screened in the 2005-2009 era compared to 1999-2004, most likely due to OB/GYN physicians' screening of prenatal women. Physician education on HBV vaccination/tr-eatment or appropriate referral should include OB/GYN as well as primary care physicians.
    Full-text · Article · Oct 2015 · Open Journal of Gastroenterology
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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.
    Full-text · Article · Jun 2014 · Annals of epidemiology
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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.
    Full-text · Article · May 2014 · BMC Infectious Diseases
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