Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA.
Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care, Palo Alto, CA.
Hepatology. 2020 Feb;71(2):431-443. doi: 10.1002/hep.30831. Epub 2019 Aug 13.
Hepatitis B virus (HBV) infection remains a major global health problem, exacerbated by poor linkage to care. We aimed to determine the prevalence of HBV infection, exposure, self-reported vaccination, vaccine-induced immunity, disease awareness, and treatment in the United States by birthplace and race/ethnicity during 1999-2016. A total of 47,628 adult participants in the National Health and Nutrition Examination Survey who completed HBV core antibody (anti-HBc) and surface antigen (HBsAg) tests and 47,618 adults who completed HBV surface antibody (anti-HBs) and anti-HBc tests were included in the analysis. HBV infection was defined by positive HBsAg and past exposure by positive anti-HBc. Vaccine-mediated immunity was defined by positive anti-HBs and negative anti-HBc. No significant change in the prevalence of HBV infection was observed between 1999 and 2016 (P = 0.442), affecting 0.35% (95% confidence interval [CI], 0.28-0.45) or 0.84 million adults. In contrast, a significant decrease in HBV exposure and increase in vaccine-mediated immunity was observed. U.S.-born persons had significantly lower prevalence of HBV infection and exposure as well as higher prevalence of vaccine-mediated immunity and self-reported vaccination than foreign-born persons. Prevalence of HBV infection was highest in non-Hispanic Asians in both foreign- (3.85%; 95% CI, 2.97-4.97) and U.S.-born (0.79%; 95% CI, 0.17-3.59) persons during 2011-2016. Among infected persons, liver disease awareness was only 15.19%, and treatment rate was only 4.60%. Conclusion: This study revealed disparities of HBV infection among ethnic/racial groups and between U.S.-born and foreign-born persons. Awareness of liver disease and treatment rate among infected persons was dismal.
乙型肝炎病毒（HBV）感染仍然是一个重大的全球健康问题，由于与护理的联系不畅而加剧。我们旨在确定 1999 年至 2016 年间，按出生地和种族/族裔划分，美国 HBV 感染、暴露、自我报告的疫苗接种、疫苗诱导的免疫、疾病意识和治疗的流行情况。共有 47628 名完成 HBV 核心抗体（抗-HBc）和表面抗原（HBsAg）检测的国家健康和营养检查调查成年参与者以及 47618 名完成 HBV 表面抗体（抗-HBs）和抗-HBc 检测的成年人被纳入分析。HBV 感染定义为 HBsAg 阳性，既往暴露定义为抗-HBc 阳性。疫苗介导的免疫定义为抗-HBs 阳性且抗-HBc 阴性。1999 年至 2016 年期间，HBV 感染的流行率没有显著变化（P=0.442），影响 0.35%（95%置信区间[CI]，0.28-0.45）或 84 万成年人。相比之下，HBV 暴露的减少和疫苗介导的免疫的增加则是显著的。与外国出生的人相比，美国出生的人 HBV 感染和暴露的流行率显著较低，疫苗介导的免疫和自我报告的疫苗接种率显著较高。在 2011 年至 2016 年期间，非西班牙裔亚裔在美国出生和外国出生的人中 HBV 感染的流行率最高（3.85%[95%CI，2.97-4.97]和 0.79%[95%CI，0.17-3.59]）。在感染者中，只有 15.19%的人意识到肝病，只有 4.60%的人接受了治疗。结论：本研究揭示了种族/族裔群体和美国出生与外国出生人群之间 HBV 感染的差异。感染者对肝病的认识和治疗率令人沮丧。
