Department of Medicine, LAC+USC Medical Center, Los Angeles, California, USA.
Division of Gastrointestinal and Liver Diseases, Department of Medicine, University of Southern California, Los Angeles, California, USA.
Hepatol Commun. 2023 Mar 24;7(4). doi: 10.1097/HC9.0000000000000081. eCollection 2023 Apr 1.
Chronic hepatitis B (HBV) prevalence is highest in foreign-born Asian and African individuals in the US, though Hispanics make up the largest proportion of the immigrant population. Differences in the diagnosis and management of chronic HBV in Hispanics might exist due to the lower awareness of risk. We aim to examine racial/ethnic disparities in the diagnosis, presentation, and immediate management of chronic HBV in a diverse safety net system enriched for Hispanics.
In a large urban safety-net hospital system, we retrospectively identified patients with chronic HBV by serological data and categorized them into mutually exclusive self-identified racial/ethnic groups: Hispanics, Asians, Blacks, and Whites. We then examined differences in screening, disease phenotype and severity, follow-up testing, and referral by race/ethnicity.
Among 1063 patients, 302 (28%) were Hispanics, 569 (54%) Asians, 161 (15%) Blacks, and 31 (3%) Whites. More Hispanics (30%) were screened in the acute setting (defined as inpatient or emergency department encounters) than Asians (13%), Blacks (17%), or Whites (23%) (p<0.01). Hispanics also had lower rates of follow-up testing after HBV diagnosis than Asians including HBeAg status (43% vs. 60%, p<0.01) and HBV DNA levels (42% vs. 58%, p<0.01) and lower rates of linkage to specialty care (32% vs. 55%, p<0.01). Among those with available testing, however, the presence of immune-active chronic HBV was infrequent and similar across racial/ethnic groups. 25% of Hispanics had cirrhosis at initial presentation, proportionally higher than other groups (p<0.01).
Our results underscore the importance of raising chronic HBV awareness and increasing both screening and linkage to care among Hispanic immigrants in addition to the existing risk groups, with the goal of mitigating downstream liver-related complications.
慢性乙型肝炎（HBV）在美国的外国出生的亚洲人和非裔人群中患病率最高，尽管西班牙裔是移民人口中占比最大的群体。由于对风险的认识较低，西班牙裔人群在慢性 HBV 的诊断和管理方面可能存在差异。我们旨在检查在一个以西班牙裔为主的多样化的医疗保障系统中，种族/族裔差异对慢性 HBV 的诊断、表现和即时管理的影响。
在一个大型城市医疗保障系统中，我们通过血清学数据回顾性地确定了慢性 HBV 患者，并将他们分为相互排斥的自我认同的种族/族裔群体：西班牙裔、亚洲人、非裔和白人。然后，我们检查了按种族/族裔划分的筛查、疾病表型和严重程度、随访检测和转介的差异。
在 1063 名患者中，302 名（28%）为西班牙裔，569 名（54%）为亚洲人，161 名（15%）为非裔，31 名（3%）为白人。与亚洲人（13%）、非裔（17%）或白人（23%）相比，更多的西班牙裔（30%）在急性环境（定义为住院或急诊就诊）中接受了筛查（p<0.01）。西班牙裔在 HBV 诊断后的随访检测率也低于亚洲人，包括 HBeAg 状态（43% vs. 60%，p<0.01）和 HBV DNA 水平（42% vs. 58%，p<0.01），以及与专科护理的联系率较低（32% vs. 55%，p<0.01）。然而，在有可用检测结果的患者中，免疫活性慢性 HBV 的存在并不常见，且在不同种族/族裔群体中相似。25%的西班牙裔患者在初次就诊时就已患有肝硬化，比例高于其他群体（p<0.01）。
我们的研究结果强调了提高西班牙裔移民对慢性 HBV 的认识并增加筛查和与护理的联系的重要性，这不仅是针对现有高危人群，还有望减轻下游与肝脏相关的并发症。
