Correlates of Hepatitis B Testing Among Chinese Americans
Correlates of Hepatitis B Testing Among Chinese Americans
Chinese Americans are 10 times more likely to be diagnosed with hepatocellular carcinoma (HCC) than their white counterparts. About 80% of HCC's among Asian immigrants are associated with hepatitis B virus (HBV) infection. We used data from in-person interviews of Chinese residents in Seattle to examine factors associated with HBV testing. The survey was completed by 206 men and 236 women (cooperation rate: 58%). Less than one-half (48%) of respondents had been tested for HBV. Factors associated (p < 0.01) with ever having tested in bivariate comparisons included knowing that Chinese are more likely to be infected with HBV than Whites; individuals can be infected with HBV for life; HBV infection can cause liver cancer; not believing that HBV can be prevented by having a positive attitude; having a family member, friend, or medical doctor recommend testing; asking for testing from a medical doctor; and not needing interpreter services. In multiple regression analyses, the following factors were independently associated with testing: believing that Chinese were more likely than Whites to get HBV (p = 0.004), having a doctor recommend testing (p ≤ 0.001), asking a doctor for the test (p < 0.001) and not needing an interpreter for doctors visits (p = 0.002). Intervention programs to improve HBV testing rates in Chinese Americans should include strategies to improve knowledge about the risk of HBV and encourage effective communication with health care providers about HBV testing.
Asian immigrants to the United States (US) have an increased prevalence of hepatitis B virus (HBV) infection compared to native-born individuals; an estimated 10% of Chinese immigrants are infected with HBV compared to less than 1% of the general US population. This increased prevalence represents one of the major reasons for the high hepatocellular carcinoma (HCC) incidence and mortality among this group; about 80% of HCC's among Asians in the US are associated with HBV infection.
Exposure to HBV can be asymptomatic or present as acute hepatitis, usually followed by immunity. However, a substantial portion of those exposed to hepatitis B becomes chronically infected (i.e., carriers). Chronically infected individuals are over 100 times more likely than others to develop liver cancer and they continue to be potentially infectious to others. A National Institutes of Health clinical conference panel concluded that patients with chronic HBV infection should be screened (with serum testing for liver tumor markers and radiologic imaging techniques) for HCC at least once a year. Additionally, chronically infected individuals should be considered for treatment with lamivudine, interferon, adefovir, liver transplantation, and new drug therapies as they become available.
Horizontal transmission of HBV through sexual and household contact leads to a high risk for infection among family members of chronic HBV carriers. Vaccines that are effective in preventing HBV infection have been available since 1981 and the vaccination of young adults from areas of high endemnicity and family members of individuals with chronic HBV infection is a standard clinical practice. Hepatitis B vaccination programs have been shown to reduce the prevalence of chronic HBV infection and the incidence of HCC.
The few previous investigations that have examined the HBV serologic testing practices of Chinese immigrants focused on women and had relatively small sample sizes. Thompson et al. report that only 35% of Chinese American and 39% of Chinese Canadian immigrant women had ever been serologically tested for HBV.
Liver cancer control programs for Chinese immigrant communities should include HBV serologic testing to identify chronically infected individuals (who may benefit from monitoring and treatment), as well as susceptible individuals (who are at risk of infection). Further, health education programs for immigrant groups should be based on a thorough understanding of the target population's health knowledge, beliefs, and practices. Using data from a community-based sample of Chinese Americans in Seattle, we sought to examine factors associated with HBV serologic testing. This report adds to the existing literature by examining the influence on testing of socio-demographic factors, health care characteristics, knowledge, health and cultural beliefs, social support, and communication with provider among Chinese Americans.
Abstract and Introduction
Abstract
Chinese Americans are 10 times more likely to be diagnosed with hepatocellular carcinoma (HCC) than their white counterparts. About 80% of HCC's among Asian immigrants are associated with hepatitis B virus (HBV) infection. We used data from in-person interviews of Chinese residents in Seattle to examine factors associated with HBV testing. The survey was completed by 206 men and 236 women (cooperation rate: 58%). Less than one-half (48%) of respondents had been tested for HBV. Factors associated (p < 0.01) with ever having tested in bivariate comparisons included knowing that Chinese are more likely to be infected with HBV than Whites; individuals can be infected with HBV for life; HBV infection can cause liver cancer; not believing that HBV can be prevented by having a positive attitude; having a family member, friend, or medical doctor recommend testing; asking for testing from a medical doctor; and not needing interpreter services. In multiple regression analyses, the following factors were independently associated with testing: believing that Chinese were more likely than Whites to get HBV (p = 0.004), having a doctor recommend testing (p ≤ 0.001), asking a doctor for the test (p < 0.001) and not needing an interpreter for doctors visits (p = 0.002). Intervention programs to improve HBV testing rates in Chinese Americans should include strategies to improve knowledge about the risk of HBV and encourage effective communication with health care providers about HBV testing.
Introduction
Asian immigrants to the United States (US) have an increased prevalence of hepatitis B virus (HBV) infection compared to native-born individuals; an estimated 10% of Chinese immigrants are infected with HBV compared to less than 1% of the general US population. This increased prevalence represents one of the major reasons for the high hepatocellular carcinoma (HCC) incidence and mortality among this group; about 80% of HCC's among Asians in the US are associated with HBV infection.
Exposure to HBV can be asymptomatic or present as acute hepatitis, usually followed by immunity. However, a substantial portion of those exposed to hepatitis B becomes chronically infected (i.e., carriers). Chronically infected individuals are over 100 times more likely than others to develop liver cancer and they continue to be potentially infectious to others. A National Institutes of Health clinical conference panel concluded that patients with chronic HBV infection should be screened (with serum testing for liver tumor markers and radiologic imaging techniques) for HCC at least once a year. Additionally, chronically infected individuals should be considered for treatment with lamivudine, interferon, adefovir, liver transplantation, and new drug therapies as they become available.
Horizontal transmission of HBV through sexual and household contact leads to a high risk for infection among family members of chronic HBV carriers. Vaccines that are effective in preventing HBV infection have been available since 1981 and the vaccination of young adults from areas of high endemnicity and family members of individuals with chronic HBV infection is a standard clinical practice. Hepatitis B vaccination programs have been shown to reduce the prevalence of chronic HBV infection and the incidence of HCC.
The few previous investigations that have examined the HBV serologic testing practices of Chinese immigrants focused on women and had relatively small sample sizes. Thompson et al. report that only 35% of Chinese American and 39% of Chinese Canadian immigrant women had ever been serologically tested for HBV.
Liver cancer control programs for Chinese immigrant communities should include HBV serologic testing to identify chronically infected individuals (who may benefit from monitoring and treatment), as well as susceptible individuals (who are at risk of infection). Further, health education programs for immigrant groups should be based on a thorough understanding of the target population's health knowledge, beliefs, and practices. Using data from a community-based sample of Chinese Americans in Seattle, we sought to examine factors associated with HBV serologic testing. This report adds to the existing literature by examining the influence on testing of socio-demographic factors, health care characteristics, knowledge, health and cultural beliefs, social support, and communication with provider among Chinese Americans.
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