Wick Jenna M, Ni Yuching, Halmer Nicole, Wong Robert J, Chitnis Amit S, Jaganath Devan, Krueger Amy L, Skarbinski Jacek
Internal Medicine Residency Program, Oakland Medical Center, Kaiser Permanente Northern California, Oakland, California, USA.
Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
Open Forum Infect Dis. 2024 Sep 3;11(9):ofae484. doi: 10.1093/ofid/ofae484. eCollection 2024 Sep.
Tuberculosis infection (TBI) and chronic hepatitis B virus (HBV) infection disproportionately affect non-US-born persons. Early identification and treatment are critical to reduce transmission, morbidity, and mortality, but little is known about screening in the United States.
We conducted a cross-sectional study in a large integrated California health system in September 2022 assessing TBI and HBV screening among persons aged ≥18 years who were born in countries with high TB burden (TB disease incidence rates ≥20/100 000 population) and/or HBV burden (hepatitis B surface antigen seroprevalence >2%).
Of 510 361 non-US-born persons born in countries with high TB burden, 322 027 (63.1%) were born in countries with high HBV burden and 188 334 (36.9%) in countries with only high TB burden. Among persons born in countries with high TB and HBV burden, 29.6% were screened for TBI, 64.5% for HBV, and 23.4% for TBI and HBV; 9.9% had TBI and 3.1% had HBV infection. Among persons born in countries with high TB burden only, 27.9% were screened for TBI and 7.5% had TBI.
Among non-US-born persons from countries with high TB and HBV burden, we found low screening rates and elevated prevalence of TBI and chronic HBV infection. Cotesting for TBI and HBV infection in non-US-born persons from countries with high TB and HBV burden might improve outcomes by identifying persons who warrant TBI treatment, HBV treatment, or HBV vaccination. Increased screening is the first step in reducing health inequities and overall disease burden.
结核感染（TBI）和慢性乙型肝炎病毒（HBV）感染对非美国出生的人群影响尤为严重。早期识别和治疗对于减少传播、发病率和死亡率至关重要，但在美国关于筛查的情况却知之甚少。
2022年9月，我们在加利福尼亚州一个大型综合卫生系统中开展了一项横断面研究，评估出生在结核病负担高（结核病发病率≥20/10万人口）和/或乙肝负担高（乙肝表面抗原血清流行率>2%）国家的18岁及以上人群的TBI和HBV筛查情况。
在出生于结核病负担高的国家的510361名非美国出生的人群中，322027人（63.1%）出生于乙肝负担高的国家，188334人（36.9%）出生于仅结核病负担高的国家。在出生于结核病和乙肝负担高的国家的人群中，29.6%接受了TBI筛查，64.5%接受了HBV筛查，23.4%接受了TBI和HBV筛查；9.9%患有TBI，3.1%患有HBV感染。在仅出生于结核病负担高的国家的人群中，27.9%接受了TBI筛查，7.5%患有TBI。
在来自结核病和乙肝负担高的国家的非美国出生人群中，我们发现筛查率较低，TBI和慢性HBV感染的患病率较高。对来自结核病和乙肝负担高的国家的非美国出生人群进行TBI和HBV感染联合检测，可能通过识别需要进行TBI治疗、HBV治疗或HBV疫苗接种的人群来改善结局。增加筛查是减少健康不平等和总体疾病负担的第一步。
