Fitzgerald S, Chao J, Feferman Y, Perumalswami P, Sarpel U
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
J Racial Ethn Health Disparities. 2016 Oct 28. doi: 10.1007/s40615-016-0296-y.
Immigrants from China and Africa have high rates of hepatitis B virus infection (HBV) and hepatocellular carcinoma (HCC); however, primary care physician (PCP) adherence to screening guidelines in at-risk communities is not well understood.
The New York City (NYC) neighborhood tabulation areas with the 25 greatest Chinese and African immigrant populations were determined based on US census data. The American Medical Association database was used to identify PCPs practicing in these neighborhoods. A Web-based survey designed to assess HBV and HCC knowledge and screening practices was distributed via e-mail to PCPs in these target areas.
A total of 2072 physicians were contacted, and 109 responded to the survey, for a response rate of 5.3 %. Among responding physicians, 73 % report routinely testing immigrant patients for HBV. However, if a patient tests positive for HBV, only 68 % of providers recommend screening for HCC. Over a quarter of PCPs (27 %), failed to correctly state that antiviral therapy can lower the risk of developing HCC, and only 56 % correctly replied that screening for liver cancer improves survival. Of responders, only 54 % answered correctly that a 25-year-old patient from Africa with HBV should be screened for HCC, whereas 53 % answered incorrectly that a 25-year-old patient from China with HBV should be screened, demonstrating a lack of awareness of the different age of onset of liver cancer in the two groups. The most commonly reported barrier to offering both HBV testing and HCC screening was a "lack of clear guidelines." Neither HBV nor HCC was among the top 3 health concerns of patients, as perceived by their physicians. There were no significant differences between provider responses in Chinese and African immigrant neighborhoods.
Providers serving Chinese and African immigrants in NYC often fail to recommend appropriate HBV and HCC screening. This appears to be due to significant gaps in provider knowledge and a lack of awareness of established screening guidelines. This study suggests the need for better distribution of existing guidelines to physicians serving immigrant-rich communities in order to improve HBV and HCC screening in high-risk individuals.
来自中国和非洲的移民中，乙肝病毒（HBV）感染率和肝细胞癌（HCC）发病率较高；然而，基层医疗医生（PCP）对高危社区筛查指南的遵循情况尚不清楚。
根据美国人口普查数据，确定纽约市（NYC）华裔和非裔移民人口最多的25个社区分区。利用美国医学协会数据库，确定在这些社区执业的基层医疗医生。通过电子邮件向这些目标地区的基层医疗医生发放一项旨在评估乙肝病毒和肝细胞癌知识及筛查实践的网络调查问卷。
共联系了2072名医生，109名医生回复了调查问卷，回复率为5.3%。在回复的医生中，73%报告常规对移民患者进行乙肝病毒检测。然而，如果患者乙肝病毒检测呈阳性，只有68%的医疗服务提供者建议进行肝细胞癌筛查。超过四分之一的基层医疗医生（27%）未能正确指出抗病毒治疗可降低患肝细胞癌的风险，只有56%正确回答肝癌筛查可提高生存率。在回复者中，只有54%正确回答来自非洲的25岁乙肝病毒感染患者应进行肝细胞癌筛查，而53%错误回答来自中国的25岁乙肝病毒感染患者应进行筛查，这表明对两组肝癌发病年龄差异缺乏认识。提供乙肝病毒检测和肝细胞癌筛查最常报告的障碍是“缺乏明确的指南”。在医生看来，乙肝病毒和肝细胞癌都不在患者最关注的三大健康问题之列。华裔和非裔移民社区的医疗服务提供者的回复没有显著差异。
在纽约市为华裔和非裔移民服务的医疗服务提供者常常未能推荐适当的乙肝病毒和肝细胞癌筛查。这似乎是由于医疗服务提供者知识存在重大差距以及对既定筛查指南缺乏认识。本研究表明，需要更好地向为移民众多社区服务的医生分发现有指南，以改善高危个体的乙肝病毒和肝细胞癌筛查。
