摘要：Objectives. To measure disparities in hepatitis B virus (HBV) infection and immunity among a high-risk patient population at a community health center in New York City. Methods. We performed a retrospective chart review of 25 565 adults with HBV surface antigen, surface antibody, and total core antibody tests from 1997 to 2017. We categorized HBV test results by infection and immunity status and analyzed by demographic characteristics with χ2 and logistic regression analysis. Results. Of 25 565 adults, 13.4% were currently infected, 52.1% were ever infected, 33.4% were immune from vaccination, and 14.5% were susceptible. Significant factors associated with ever infection were age, male sex, being China-born, limited English proficiency, having Medicaid or no insurance, and family history of HBV ( P < .01). Conclusions. Our study demonstrated a high burden of HBV infection among foreign-born Asian Americans seeking care at a community health center. Public Health Implications. It is important to test patients at high risk for HBV infection with all 3 tests to identify those with current infection, risk for reactivation, or need for vaccination, and to assess the effectiveness of public health interventions. An estimated 257 million people in the world are living with chronic hepatitis B virus (HBV) infection, 1 the world’s leading cause of liver cancer. Two thirds of those chronically infected in the United States are unaware of their status. 2 Universal childhood vaccination programs since the 1980s have sharply reduced new HBV infections in regions with high HBV endemicity while increasing immunity from vaccination. 3–6 Yet, an estimated one third of the world’s population still has a history of infection. 1 In the United States, HBV infection is a significant racial health disparity, with Asian Americans and Pacific Islanders making up more than 50% of those with HBV infection. 7,8 Approximately 10% of Asian American and Pacific Islander adults are chronically infected with HBV, 7 compared with fewer than 0.3% of the overall US population. 9 If unmonitored and untreated, 1 in 4 will die prematurely from liver failure or liver cancer associated with HBV infection. 10 Charles B. Wang Community Health Center (Health Center) is a federally qualified health center in New York City that serves a primarily low-income Asian population and provides multidisciplinary care. The Health Center has a patient population with a high burden of HBV infection 11 and tracks more than 8000 patients in a chronic HBV registry. Its Hepatitis B Program coordinates comprehensive and culturally appropriate HBV services and provides care management for patients with chronic HBV infection who are pregnant, uninsured and deemed high-risk, or require treatment. The Health Center was able to augment its work in hepatitis B with the adoption of an electronic medical record system so that HBV-infected patients could be systematically identified, registries created, and HBV-directed modifications made to prompt screening and regular HBV care. The Health Center implemented universal HBV screening with HBV total core antibody (anti-HBc) in addition to HBV surface antigen (HBsAg) and HBV surface antibody (anti-HBs) through its electronic medical record HBV serology order set to assess complete HBV status. In earlier years, testing was often done with only HBsAg and anti-HBs, partly because of expense and the complex serological interpretation that resulted. However, this practice changed with rising awareness of the importance of identifying those with prior infection and the known high rates of HBV exposure in foreign-born persons. 12,13 Growing data showed that covalently closed circular DNA of HBV remains in individuals even after resolving their natural infection, and reactivation of HBV with the risk of fulminant liver failure can occur in the setting of immunocompromise, such as with chemotherapy or other immunosuppressive treatments. 14,15 Furthermore, counseling for those with prior HBV infection (HBsAg-negative and anti-HBc–positive) was modified to discuss the small risk for HBV reactivation on immunosuppressive therapy. 14 The purpose of this study was to measure disparities in HBV infection and immunity among a high-risk patient population at a community health center in New York City by using HBsAg, anti-HBs, and anti-HBc screening tests.
