Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
ICES, Toronto, Ontario, Canada.
Hepatology. 2022 Mar;75(3):673-689. doi: 10.1002/hep.32162. Epub 2021 Dec 7.
The global burden of viral hepatitis B is substantial, and monitoring infections across the care cascade is important for elimination efforts. There is little information on care disparities by immigration status, and we aimed to quantify disease burden among immigrant subgroups.
In this population-based, retrospective cohort study, we used linked laboratory and health administrative records to describe the HBV care cascade in five distinct stages: (1) lifetime prevalence; (2) diagnosis; (3) engagement with care; (4) treatment initiation; and (5) treatment continuation. Infections were identified based on at least one reactive antigen or nucleic acid test, and lifetime prevalence was estimated as the sum of diagnosed and estimated undiagnosed cases. Care cascades were compared between long-term residents and immigrant groups, including subgroups born in hepatitis B endemic countries. Stratified analyses and multivariable Poisson regression were used to identify drivers for cascade progression. Between January 1997 and December 2014, 2,014,470 persons were included, 50,475 with infections, of whom 30,118 were engaged with care, 11,450 initiated treatment, and 6554 continued treatment >1 year. Lifetime prevalence was estimated as 163,309 (1.34%) overall, 115,722 (3.42%) among all immigrants, and 50,876 (9.37%) among those from highly endemic countries. Compared to long-term residents, immigrants were more likely to be diagnosed (adjusted rate ratio [aRR], 4.55; 95% CI, 4.46, 4.63), engaged with care (aRR, 1.07; 95% CI, 1.04, 1.09), and initiate treatment (aRR, 1.09; 95% CI, 1.03, 1.16).
In conclusion, immigrants fared well compared to long-term residents along the care cascade, having higher rates of diagnosis and slightly better measures in subsequent cascade stages, although intensified screening efforts and better strategies to facilitate linkage to care are still needed.
乙型肝炎病毒（HBV）在全球的负担较重，对整个治疗过程中的感染进行监测对消除工作至关重要。关于移民身份的护理差异信息很少，我们旨在量化移民亚群的疾病负担。
在这项基于人群的回顾性队列研究中，我们使用了实验室和健康管理记录的链接来描述五个不同阶段的 HBV 护理过程：（1）终生患病率；（2）诊断；（3）参与治疗；（4）开始治疗；（5）持续治疗。感染根据至少一次抗原或核酸检测的阳性结果来确定，终生患病率估计为确诊和估计未确诊病例的总和。比较了长期居民和移民群体（包括来自乙型肝炎流行国家的亚组）之间的护理过程。分层分析和多变量泊松回归用于确定过程进展的驱动因素。1997 年 1 月至 2014 年 12 月，共纳入 2014470 人，其中 50475 人感染，30118 人参与治疗，11450 人开始治疗，6554 人持续治疗>1 年。总体终生患病率估计为 163309（1.34%），所有移民为 115722（3.42%），来自高度流行国家的移民为 50876（9.37%）。与长期居民相比，移民更有可能被诊断（调整后的率比[aRR]，4.55；95%置信区间[CI]，4.46，4.63），参与治疗（aRR，1.07；95%CI，1.04，1.09）和开始治疗（aRR，1.09；95%CI，1.03，1.16）。
总之，与长期居民相比，移民在护理过程中表现良好，诊断率较高，随后的过程阶段的治疗措施略好，但仍需要加强筛查力度并制定更好的策略以促进与护理的衔接。
