移民因素与外国出生人群慢性乙型肝炎感染的监测：FOCUS-HBV多中心队列研究

Immigration Factors and Monitoring of Chronic Hepatitis B Infection Among Foreign-Born: The FOCUS-HBV Multicentre Cohort.

作者信息

Zhou Kali, Lee Ariel, Wong Christopher, Rangnekar Amol S, Chen Ariana, Ajokubi James, Keller Andrea I, Smith Coleman I, Hitawala Asif A, Mironova Maria, Gopalakrishna Harish, Norman-Wheeler Jaha, Ghany Marc G, Dodge Jennifer L, Terrault Norah A, Hsu Christine C

机构信息

Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.

Medstar Georgetown Transplant Institute, Washington, DC, USA.

出版信息

Aliment Pharmacol Ther. 2025 Jun;61(12):1913-1922. doi: 10.1111/apt.70123. Epub 2025 Apr 9.

DOI:10.1111/apt.70123

PMID:40202373

Abstract

BACKGROUND

Immigrants are the largest subgroup living with chronic hepatitis B (HBV) infection in the United States. It is not well understood how immigration and associated social and cultural factors impact adherence to HBV monitoring.

METHODS

We conducted a multicentre multilingual survey among foreign-born adults with chronic HBV between 7/2021 and 4/2023. Participants were surveyed regarding (1) immigration factors, (2) acculturation and language preferences, (3) social determinants of health and (4) HBV-related clinical factors. The primary outcome was optimal adherence, defined as 100% of the time with at least annual testing of HBV DNA, ALT and ultrasound while under care. Logistic regression was used to examine survey factors associated with the outcome.

RESULTS

Two hundred and seventy-four foreign-born patients with HBV (median 57 years, 57% male) from 32 birth countries were included. Thirteen per cent had immigrated within the past 10 years, and 62% were US citizens. Nearly all (92%) reported seeing a specialist for HBV, with 72% currently on treatment. 44% of participants had optimal adherence to monitoring over a median of 6 years (2-7) under care. Factors associated with more optimal adherence on multivariate testing included non-English survey language (OR 2.32, 95% CI 1.15-4.66), non-US citizens (OR 2.05, 95% CI 1.01-4.15) and higher education (college vs. high school or less: OR 2.39, 95% CI 1.09-5.24). Medicare insurance (vs. private) was associated with less optimal adherence (OR 0.42, 95% CI 0.19-0.94).

CONCLUSION

Adherence to long-term monitoring is suboptimal among a diverse cohort of immigrants with chronic HBV. More efforts to engage and retain immigrants in care are needed.

摘要

背景

在美国，移民是感染慢性乙型肝炎（HBV）人数最多的亚群体。目前尚不清楚移民及相关社会文化因素如何影响对HBV监测的依从性。

方法

在2021年7月至2023年4月期间，我们对出生在国外的慢性HBV成年患者开展了一项多中心、多语言调查。调查内容包括：（1）移民因素；（2）文化适应和语言偏好；（3）健康的社会决定因素；（4）与HBV相关的临床因素。主要结局为最佳依从性，定义为在接受治疗期间，至少每年检测一次HBV DNA、ALT和进行超声检查的时间占100%。采用逻辑回归分析与该结局相关的调查因素。

结果

纳入了来自32个出生国家的274例出生在国外的HBV患者（中位年龄57岁，57%为男性）。13%的患者在过去10年内移民，62%为美国公民。几乎所有患者（92%）报告曾因HBV就诊于专科医生，72%的患者目前正在接受治疗。在接受治疗的中位时间6年（2 - 7年）内，44%的参与者对监测具有最佳依从性。多因素分析中，与更佳依从性相关的因素包括非英语调查语言（比值比[OR] 2.32，95%置信区间[CI] 1.15 - 4.66）、非美国公民（OR 2.05，95% CI 1.01 - 4.15）和高等教育程度（大学学历与高中学历或更低学历相比：OR 2.39，95% CI 1.09 - 5.24）。医疗保险为医疗保险（与私人保险相比）与更佳依从性降低相关（OR 0.42，95% CI 0.19 - 0.94）。