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

Abstract

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. (HEPATOLOGY 2012;56:422-433)

Care delivery and outcomes among US veterans with hepatitis B: A national cohort study

“…From the 1 Gastroenterology Section, and 2 Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA; 3 Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA; 4 Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.…”

“…In the United States, the prevalence of chronic hepatitis B remains incompletely quantified, with estimates ranging from approximately 800,000 individuals to as high as 2.2 million when including foreign-born Americans. (1,2) Chronic HBV infection is a significant cause of morbidity and mortality, leading to liver failure, cirrhosis, and hepatocellular carcinoma (HCC) in 25%-40% of infected persons. (3) Specifically, in the United States, hepatitis B is the underlying cause of an estimated 1800-4000 deaths each year.…”

“…(3) Specifically, in the United States, hepatitis B is the underlying cause of an estimated 1800-4000 deaths each year. (2,4) Despite the significant burden of disease and existence of management guidelines for the evaluation and treatment of chronic HBV, (5) studies have shown variable adherence to recommended HBV care, including low rates of alanine aminotransferase (ALT) and HBV DNA level monitoring and infrequent HCC surveillance. (6,7) Significant gaps in care were noted across…”

Characteristics of Liver Cancer at Khmer-Soviet Friendship Hospital in Phnom Penh, Cambodia

“…Many studies reported the prevalence of hepatitis infection among Cambodians. The reported prevalence varied largely among different geographical areas and different periods of survey; 7.7% to 11.8% for HBV and 2.3% to 14.7% for HCV (Thuring et al, 1993;Sarmati et al, 2003;Buchy et al, 2004;Caruana, 2005;Ha et al, 2009;Sann et al, 2009;Sa-Nguanmoo, 2010;Akkarathamrongsin et al, 2011;Kowdley et al, 2012). Among those with elevated serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) measured at Pasteur Institute Phnom Penh, 41% and 39% were found to be positive for HBV antigen and HCV antibody, respectively (Buchy et al, 2004).…”

Hepatitis B in the United States: A major health disparity affecting many foreign-born populations

“…1,2 High rates of chronic hepatitis B among the US foreign born reflect the large global burden of hepatitis B, 370 million persons around the world, and the migration to the US from countries where prevalence of hepatitis B virus (HBV) is highest. More than 60% of new immigrants to the US come from countries of increased hepatitis B endemicity (hepatitis B surface antigen [HBsAg] prevalence of 2%).…”