An Updated Assessment of Chronic Hepatitis B Prevalence Among Foreign‐Born Persons Living in the United States

Background In 2019, an estimated 296 million people were living with chronic hepatitis B virus (HBV) globally with approximately 2.4 million living within the United States. Those living with HBV require years if not decades of regular monitoring to prevent liver complications from occurring. The aim of this study was to explore the working conceptual framework of health related quality of life (HRQL) for those living with chronic HBV through qualitative analysis. Methods Data were collected by in-depth telephone interviews conducted in 2019 using purposeful sampling as part of a disease understanding assessment on the HBV patient experience within the United States. A directed content analysis approach was utilized by creation of a codebook to guide the organization of data, codes were developed by review of the literature (a priori) and through line-by-line reading of a subsample of queries. All transcripts were analyzed by at least two members of the study team and intercoder reliability was assessed using Dedoose software. Findings A sample of 19 individuals living with chronic HBV were included within this study. Themes identified from transcripts noted the significant overlap between the reported experience of HBV and constructs within the HRQL model. The psychological impact of chronic HBV on study participants’ HRQL overall was considerable and contributed to depression, anxiety, homelessness, drug use, and incarceration. Conclusion Our analysis supports the hypothesis that HBV impacts HRQL and often negatively affects emotional health. Our findings suggest that it would be beneficial to include HRQL assessment in the medical management of HBV, so that interventions can focus on reducing the burden of disease and improving quality of life for those living with HBV.

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“…Author details 1 Hepatitis B Foundation, 3805 Old Easton Rd., Doylestown, PA 18902, USA. 2 FRCP GSK Research and Development, Stevenage, UK.…”

Section: Supplementary Informationmentioning

confidence: 99%

“…In 2019, an estimated 296 million people were living with chronic hepatitis B virus (HBV) globally with 2.4 million living within the United States [ 1 , 2 ]. Left untreated, chronic HBV infection can lead to serious liver complications and premature death.…”

Section: Introductionmentioning

confidence: 99%

Health-related quality of life for adults living with hepatitis B in the United States: a qualitative assessment

Freeland

Racho

Kamischke

et al. 2021

J Patient Rep Outcomes

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“…Those living with chronic hepatitis B virus (HBV) require years, if not decades, of regular monitoring to prevent liver complications from occurring and improve HBV‐related mortality 1 . An estimated 292 million people were living with chronic HBV globally in 2018 with approximately 2.4 million of those residing within the United States (US) 2‐4 . Left untreated, chronic HBV infection can lead to serious liver complications and premature death.…”

Section: Introduction/backgroundmentioning

confidence: 99%

Cure everyone and vaccinate the rest: The patient perspective on future hepatitis B treatment

Freeland

Racho

Kamischke

et al. 2021

Journal of Viral Hepatitis

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Those living with chronic hepatitis B virus (HBV) require years, if not decades, of regular monitoring to prevent liver complications from occurring. An estimated 292 million people were living with chronic HBV globally in 2018 with approximately 2.4 million of those residing within the United States (US). This study is one of the first of its kind that aims to explore the treatment preferences for those living with chronic HBV through qualitative interviews. Participant data were collected by in‐depth telephone interviews using a semi‐structured discussion guide. A codebook guided the organization of data, and codes were developed by review of the literature (a priori) and through line‐by‐line reading of a subsample of queries. All data transcripts (N = 19) were independently double coded. Overarching themes identified from the data specific to the treatment modalities and implications of a functional HBV cure included the concern about side effects, treatment modality, frequency, duration, cost‐effectiveness and overall impact on their lives. Qualitative data analysis revealed the significant impact that an HBV functional cure would have on quality of life. Benefits of a cure were described as not having a finite course of treatment, improving overall vitality, and reducing the fear and anxiety associated with lifelong infection and potential development of liver cancer. Many individuals expressed the desire for a cure for HBV, stating it would be life‐changing, and a ‘miracle’. As new therapies are in development, more research should examine in detail the treatment preferences of those living with HBV.

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“…To provide undiagnosed fraction estimates among immigrant groups, we used country-of-birth prevalence estimates from Schweitzer et al 2015 andWong et al 2021, along with population-level census estimates in Ontario, to calculate the number of diagnoses estimated in Ontario based on country of birth. We then used the observed number of diagnoses made by the public health laboratory to calculate the undiagnosed fraction for each country, with the following formula:…”

Section: Discussionmentioning

confidence: 99%

The viral hepatitis B care cascade: A population‐based comparison of immigrant groups

et al. 2021

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Background and Aims The global burden of viral hepatitis B is substantial, and monitoring infections across the care cascade is important for elimination efforts. There is little information on care disparities by immigration status, and we aimed to quantify disease burden among immigrant subgroups. Approach and Results In this population‐based, retrospective cohort study, we used linked laboratory and health administrative records to describe the HBV care cascade in five distinct stages: (1) lifetime prevalence; (2) diagnosis; (3) engagement with care; (4) treatment initiation; and (5) treatment continuation. Infections were identified based on at least one reactive antigen or nucleic acid test, and lifetime prevalence was estimated as the sum of diagnosed and estimated undiagnosed cases. Care cascades were compared between long‐term residents and immigrant groups, including subgroups born in hepatitis B endemic countries. Stratified analyses and multivariable Poisson regression were used to identify drivers for cascade progression. Between January 1997 and December 2014, 2,014,470 persons were included, 50,475 with infections, of whom 30,118 were engaged with care, 11,450 initiated treatment, and 6554 continued treatment >1 year. Lifetime prevalence was estimated as 163,309 (1.34%) overall, 115,722 (3.42%) among all immigrants, and 50,876 (9.37%) among those from highly endemic countries. Compared to long‐term residents, immigrants were more likely to be diagnosed (adjusted rate ratio [aRR], 4.55; 95% CI, 4.46, 4.63), engaged with care (aRR, 1.07; 95% CI, 1.04, 1.09), and initiate treatment (aRR, 1.09; 95% CI, 1.03, 1.16). Conclusions In conclusion, immigrants fared well compared to long‐term residents along the care cascade, having higher rates of diagnosis and slightly better measures in subsequent cascade stages, although intensified screening efforts and better strategies to facilitate linkage to care are still needed.

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An Updated Assessment of Chronic Hepatitis B Prevalence Among Foreign‐Born Persons Living in the United States

Cited by 91 publications

References 22 publications

Health-related quality of life for adults living with hepatitis B in the United States: a qualitative assessment

Health-related quality of life for adults living with hepatitis B in the United States: a qualitative assessment

Cure everyone and vaccinate the rest: The patient perspective on future hepatitis B treatment

The viral hepatitis B care cascade: A population‐based comparison of immigrant groups

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