Racial Disparities in Hepatitis B Infection, Vaccination, and Screening

Introduction: Chronic hepatitis B infection, the leading cause of HCC worldwide, disproportionately affects Asian-Americans, particularly those born outside of the U.S. Our study assessed hepatitis B screening and vaccination rates among Chinese patients at New York University Langone Health Brooklyn outpatient clinics. Methods: The study consisted of self-identifying Chinese patients with at least 1 visit with the New York University Brooklyn health system in the past year. Through chart review followed by a telephone survey, we ascertained rates of hepatitis B screening, vaccination, and investigated factors associated with accessing hepatitis B preventative care. For participating patients, we contacted PCPs to schedule vaccination. Results: Of 605 Chinese patients included at New York University Langone Health Brooklyn, 51.9% had been screened for hepatitis B infection and 23.5% were vaccinated against hepatitis B. Of those tested, the rate of chronic hepatitis B was 10.8% (Hbsag+). Being born in the United States was a positive predictor for vaccination (P< 0.01), while being born in China was a negative predictor for vaccination (P< 0.01) and positive predictor for chronic hepatitis B infection (P< 0.01). Of 151 patients participating in our telephone survey, knowledge regarding hepatitis B and regular follow up with a PCP were positive predictive variables for vaccination ( P=0.02 and P=0.001). Of the 48 participants not vaccinated against hepatitis B, 32 indicated interest in screening and vaccination (66.7%). We were able to contact 18 of these patients’ PCPs to initiate screening and vaccination. One month after this initial contact, we followed up with the PCPs and learned that 8 of the 18 patients had been screened for hepatitis B (44.4%). Of these 8, serologic testing demonstrated immunity in 6 patients (75%). Of the 2 without serologic immunity, 1 patient subsequently received vaccination. Conclusion: There is an increased burden of HBV among this urban, underserved population and decreased rates of vaccination and screening among this high-risk group. This disparity is more pronounced among Chinese-born patients. While hepatitis B screening and vaccination is recommended for all U.S. adults, it remains significantly underutilized, especially among groups that are disproportionately affected by HBV. Regular PCP follow up and knowledge regarding hepatitis B were positive predictors for vaccination, suggesting that these variables could be targeted in future interventions aiming to improve preventative health behaviors (Table 1). Table 1. - Comparing hepatitis B screening and vaccination among China-born and US-born Chinese patients at New York University Langone Brooklyn China born US born Percentage screened for Hep B 64.3% 93.6% Hbsag+ 11% 0% Hbsab+ 31.8% 91.5% Vaccinated 21.4% 89.4%