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Abstract Details
An Updated Assessment of Chronic Hepatitis B Prevalence Among Foreign-Born Persons Living in the United States
Hepatology. 2021 Mar 3. doi: 10.1002/hep.31782. Online ahead of print.
Robert J Wong12, Carol L Brosgart3, Sue Welch4, Tim Block56, Mark Chen4, Chari Cohen56, W Ray Kim1, Kris V Kowdley7, Anna S Lok8, Naoky Tsai9, John Ward10, Steven S Wong4, Robert G Gish5
Author information
1Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA.
2Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA.
3Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, CA.
4Plan A, Inc., Mountain View, CA.
5Hepatitis B Foundation, Doylestown, PA.
6Baruch S Blumberg Institute, Doylestown, PA.
7Liver Institute Northwest, Seattle, WA.
8Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI.
9University of Hawaii, Honolulu, HI.
10Coalition for Global Hepatitis Elimination, Task Force for Global Health, Decatur, GA.
PMID: 33655536
DOI: 10.1002/hep.31782
Abstract
Background and aims: Although prevalence of chronic hepatitis B (CHB) in the USA includes 0.42 million (range, 0.28-0.67) U.S.-born persons, foreign-born (FB) persons contribute a substantially larger number to the burden of CHB in the USA. Over the past decade, patterns of U.S. immigration have changed and many countries have implemented HBV prevention programs. This study aims to estimate the number of FB persons with CHB in the USA by country of origin, updating our 2011 study.
Approach and results: We performed systematic searches for articles published in 2009-2019 reporting HBsAg seroprevalence in emigrants and in-country populations of 117 countries. Data meeting inclusion criteria were combined with data from our 2011 study to calculate pooled prevalence estimates for 99 countries using meta-analyses (total 2,800 surveys involving 112 million subjects). Combining country-specific CHB rate estimates with the number of FB in the USA in 2018, by country of origin from the U.S. Census Bureau, we estimate that the number of FB with CHB in the USA in 2018 was 1.47 million (95% CI, 1.21-1.73), substantially higher than previously reported. The weighted average CHB prevalence for all FB in the USA in 2018 was 3.07%. Approximately 59% of FB with CHB in the USA in 2018 emigrated from Asia, 19% from the Americas, and 15% from Africa. Subgroup analyses found that for many countries, CHB rates are higher in males than females and have declined over the past three decades, but no consistent pattern is observed between emigrant and in-country rates.
Conclusions: Including FB and U.S.-born persons, the total prevalence of CHB in the USA may be as high as 2.4 million.