An Updated Assessment of Chronic Hepatitis B Prevalence Among Foreign‐Born Persons Living in the United States

Background and Aims Although prevalence of chronic hepatitis B (CHB) in the USA includes 0.42 million (range, 0.28‐0.67) U.S.‐born persons, foreign‐born (FB) persons contribute a substantially larger number to the burden of CHB in the USA. Over the past decade, patterns of U.S. immigration have chan...

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Published inHepatology (Baltimore, Md.) Vol. 74; no. 2; pp. 607 - 626
Main Authors Wong, Robert J., Brosgart, Carol L., Welch, Sue, Block, Tim, Chen, Mark, Cohen, Chari, Kim, W. Ray, Kowdley, Kris V., Lok, Anna S., Tsai, Naoky, Ward, John, Wong, Steven S., Gish, Robert G.
Format Journal Article
LanguageEnglish
Published United States Wolters Kluwer Health, Inc 01.08.2021
John Wiley and Sons Inc
Subjects
Emigrants and Immigrants - statistics & numerical data
Hepatitis
Hepatitis B
Hepatitis B surface antigen
Hepatitis B virus - isolation & purification
Hepatitis B, Chronic - blood
Hepatitis B, Chronic - epidemiology
Hepatology
Humans
Immigration
Original
Prevalence
Seroepidemiologic Studies
Serology
Sex differences
United States > US
Online AccessGet full text

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Abstract Background and Aims Although prevalence of chronic hepatitis B (CHB) in the USA includes 0.42 million (range, 0.28‐0.67) U.S.‐born persons, foreign‐born (FB) persons contribute a substantially larger number to the burden of CHB in the USA. Over the past decade, patterns of U.S. immigration have changed and many countries have implemented HBV prevention programs. This study aims to estimate the number of FB persons with CHB in the USA by country of origin, updating our 2011 study. Approach and Results We performed systematic searches for articles published in 2009–2019 reporting HBsAg seroprevalence in emigrants and in‐country populations of 117 countries. Data meeting inclusion criteria were combined with data from our 2011 study to calculate pooled prevalence estimates for 99 countries using meta‐analyses (total 2,800 surveys involving 112 million subjects). Combining country‐specific CHB rate estimates with the number of FB in the USA in 2018, by country of origin from the U.S. Census Bureau, we estimate that the number of FB with CHB in the USA in 2018 was 1.47 million (95% CI, 1.21‐1.73), substantially higher than previously reported. The weighted average CHB prevalence for all FB in the USA in 2018 was 3.07%. Approximately 59% of FB with CHB in the USA in 2018 emigrated from Asia, 19% from the Americas, and 15% from Africa. Subgroup analyses found that for many countries, CHB rates are higher in males than females and have declined over the past three decades, but no consistent pattern is observed between emigrant and in‐country rates. Conclusions Including FB and U.S.‐born persons, the total prevalence of CHB in the USA may be as high as 2.4 million.
AbstractList Although prevalence of chronic hepatitis B (CHB) in the USA includes 0.42 million (range, 0.28-0.67) U.S.-born persons, foreign-born (FB) persons contribute a substantially larger number to the burden of CHB in the USA. Over the past decade, patterns of U.S. immigration have changed and many countries have implemented HBV prevention programs. This study aims to estimate the number of FB persons with CHB in the USA by country of origin, updating our 2011 study. We performed systematic searches for articles published in 2009-2019 reporting HBsAg seroprevalence in emigrants and in-country populations of 117 countries. Data meeting inclusion criteria were combined with data from our 2011 study to calculate pooled prevalence estimates for 99 countries using meta-analyses (total 2,800 surveys involving 112 million subjects). Combining country-specific CHB rate estimates with the number of FB in the USA in 2018, by country of origin from the U.S. Census Bureau, we estimate that the number of FB with CHB in the USA in 2018 was 1.47 million (95% CI, 1.21-1.73), substantially higher than previously reported. The weighted average CHB prevalence for all FB in the USA in 2018 was 3.07%. Approximately 59% of FB with CHB in the USA in 2018 emigrated from Asia, 19% from the Americas, and 15% from Africa. Subgroup analyses found that for many countries, CHB rates are higher in males than females and have declined over the past three decades, but no consistent pattern is observed between emigrant and in-country rates. Including FB and U.S.-born persons, the total prevalence of CHB in the USA may be as high as 2.4 million.
Although prevalence of chronic hepatitis B (CHB) in the USA includes 0.42 million (range, 0.28-0.67) U.S.-born persons, foreign-born (FB) persons contribute a substantially larger number to the burden of CHB in the USA. Over the past decade, patterns of U.S. immigration have changed and many countries have implemented HBV prevention programs. This study aims to estimate the number of FB persons with CHB in the USA by country of origin, updating our 2011 study.BACKGROUND AND AIMSAlthough prevalence of chronic hepatitis B (CHB) in the USA includes 0.42 million (range, 0.28-0.67) U.S.-born persons, foreign-born (FB) persons contribute a substantially larger number to the burden of CHB in the USA. Over the past decade, patterns of U.S. immigration have changed and many countries have implemented HBV prevention programs. This study aims to estimate the number of FB persons with CHB in the USA by country of origin, updating our 2011 study.We performed systematic searches for articles published in 2009-2019 reporting HBsAg seroprevalence in emigrants and in-country populations of 117 countries. Data meeting inclusion criteria were combined with data from our 2011 study to calculate pooled prevalence estimates for 99 countries using meta-analyses (total 2,800 surveys involving 112 million subjects). Combining country-specific CHB rate estimates with the number of FB in the USA in 2018, by country of origin from the U.S. Census Bureau, we estimate that the number of FB with CHB in the USA in 2018 was 1.47 million (95% CI, 1.21-1.73), substantially higher than previously reported. The weighted average CHB prevalence for all FB in the USA in 2018 was 3.07%. Approximately 59% of FB with CHB in the USA in 2018 emigrated from Asia, 19% from the Americas, and 15% from Africa. Subgroup analyses found that for many countries, CHB rates are higher in males than females and have declined over the past three decades, but no consistent pattern is observed between emigrant and in-country rates.APPROACH AND RESULTSWe performed systematic searches for articles published in 2009-2019 reporting HBsAg seroprevalence in emigrants and in-country populations of 117 countries. Data meeting inclusion criteria were combined with data from our 2011 study to calculate pooled prevalence estimates for 99 countries using meta-analyses (total 2,800 surveys involving 112 million subjects). Combining country-specific CHB rate estimates with the number of FB in the USA in 2018, by country of origin from the U.S. Census Bureau, we estimate that the number of FB with CHB in the USA in 2018 was 1.47 million (95% CI, 1.21-1.73), substantially higher than previously reported. The weighted average CHB prevalence for all FB in the USA in 2018 was 3.07%. Approximately 59% of FB with CHB in the USA in 2018 emigrated from Asia, 19% from the Americas, and 15% from Africa. Subgroup analyses found that for many countries, CHB rates are higher in males than females and have declined over the past three decades, but no consistent pattern is observed between emigrant and in-country rates.Including FB and U.S.-born persons, the total prevalence of CHB in the USA may be as high as 2.4 million.CONCLUSIONSIncluding FB and U.S.-born persons, the total prevalence of CHB in the USA may be as high as 2.4 million.
Background and AimsAlthough prevalence of chronic hepatitis B (CHB) in the USA includes 0.42 million (range, 0.28‐0.67) U.S.‐born persons, foreign‐born (FB) persons contribute a substantially larger number to the burden of CHB in the USA. Over the past decade, patterns of U.S. immigration have changed and many countries have implemented HBV prevention programs. This study aims to estimate the number of FB persons with CHB in the USA by country of origin, updating our 2011 study.Approach and ResultsWe performed systematic searches for articles published in 2009–2019 reporting HBsAg seroprevalence in emigrants and in‐country populations of 117 countries. Data meeting inclusion criteria were combined with data from our 2011 study to calculate pooled prevalence estimates for 99 countries using meta‐analyses (total 2,800 surveys involving 112 million subjects). Combining country‐specific CHB rate estimates with the number of FB in the USA in 2018, by country of origin from the U.S. Census Bureau, we estimate that the number of FB with CHB in the USA in 2018 was 1.47 million (95% CI, 1.21‐1.73), substantially higher than previously reported. The weighted average CHB prevalence for all FB in the USA in 2018 was 3.07%. Approximately 59% of FB with CHB in the USA in 2018 emigrated from Asia, 19% from the Americas, and 15% from Africa. Subgroup analyses found that for many countries, CHB rates are higher in males than females and have declined over the past three decades, but no consistent pattern is observed between emigrant and in‐country rates.ConclusionsIncluding FB and U.S.‐born persons, the total prevalence of CHB in the USA may be as high as 2.4 million.
Background and Aims Although prevalence of chronic hepatitis B (CHB) in the USA includes 0.42 million (range, 0.28‐0.67) U.S.‐born persons, foreign‐born (FB) persons contribute a substantially larger number to the burden of CHB in the USA. Over the past decade, patterns of U.S. immigration have changed and many countries have implemented HBV prevention programs. This study aims to estimate the number of FB persons with CHB in the USA by country of origin, updating our 2011 study. Approach and Results We performed systematic searches for articles published in 2009–2019 reporting HBsAg seroprevalence in emigrants and in‐country populations of 117 countries. Data meeting inclusion criteria were combined with data from our 2011 study to calculate pooled prevalence estimates for 99 countries using meta‐analyses (total 2,800 surveys involving 112 million subjects). Combining country‐specific CHB rate estimates with the number of FB in the USA in 2018, by country of origin from the U.S. Census Bureau, we estimate that the number of FB with CHB in the USA in 2018 was 1.47 million (95% CI, 1.21‐1.73), substantially higher than previously reported. The weighted average CHB prevalence for all FB in the USA in 2018 was 3.07%. Approximately 59% of FB with CHB in the USA in 2018 emigrated from Asia, 19% from the Americas, and 15% from Africa. Subgroup analyses found that for many countries, CHB rates are higher in males than females and have declined over the past three decades, but no consistent pattern is observed between emigrant and in‐country rates. Conclusions Including FB and U.S.‐born persons, the total prevalence of CHB in the USA may be as high as 2.4 million.
Author Gish, Robert G.
Chen, Mark
Brosgart, Carol L.
Kowdley, Kris V.
Kim, W. Ray
Ward, John
Wong, Steven S.
Cohen, Chari
Tsai, Naoky
Wong, Robert J.
Lok, Anna S.
Welch, Sue
Block, Tim
AuthorAffiliation 8 Division of Gastroenterology and Hepatology University of Michigan Ann Arbor MI
9 University of Hawaii Honolulu HI
5 Hepatitis B Foundation Doylestown PA
7 Liver Institute Northwest Seattle WA
6 Baruch S Blumberg Institute Doylestown PA
3 Department of Medicine, Epidemiology and Biostatistics University of California San Francisco CA
10 Coalition for Global Hepatitis Elimination Task Force for Global Health Decatur GA
2 Division of Gastroenterology and Hepatology Veterans Affairs Palo Alto Healthcare System Palo Alto CA
1 Division of Gastroenterology and Hepatology Stanford University School of Medicine Stanford CA
4 Plan A, Inc. Mountain View CA
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  orcidid: 0000-0002-8923-2806
  surname: Wong
  fullname: Wong, Robert J.
  email: Rwong123@stanford.edu
  organization: Veterans Affairs Palo Alto Healthcare System
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/33655536$$D View this record in MEDLINE/PubMed
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Copyright_xml – notice: 2021 The Authors. Hepatology published by Wiley Periodicals LLC on behalf of American Association for the Study of Liver Diseases.
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2021 The Authors. Hepatology published by Wiley Periodicals LLC on behalf of American Association for the Study of Liver Diseases.
This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
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Supported by an investigator‐sponsored research grant from Gilead Sciences (IN‐US‐988‐5504).
Potential conflict of interest: Dr. R. Wong consults for, advises for, is on the speakers’ bureau for, and received grants from Gilead. He received grants from AbbVie. Dr. Brosgart consults for Dynavax. She is employed by and owns stock in Enochian. Dr. Block is employed by Cirna and Hepion. He owns stock in Arbutus and Glycotest. Dr. Cohen advises for and received grants from Gilead and GlaxoSmithKline. She received grants from Janssen and Arbutus. Dr. Kim consults for and advises for Gilead. Dr. Kowdley advises for, is on the speakers’ bureau for, and received grants from Gilead. He advises for and received grants from High Tide and Intercept. He consults for Altimmune, Roche, and Boehringer Ingelheim. He advises for Assembly and Calliditas. He received grants from Janssen, Allergan, Genfit, Novartis, Enanta, and CymaBay. Dr. Lok consults for and received grants from TARGET. She consults for Ambys, Lilly, CLEAR‐B, and Huahui. She received grants from Bristol‐Myers Squibb and Gilead. Dr. Tsai advises for, is on the speakers’ bureau for, and received grants from AbbVie, Gilead, and Intercept. Dr. Ward received grants from Gilead, AbbVie, Merck, Abbott, Cepheid, Siemens, Roche, Pharco, Zydus, and Cadila. Dr. Gish consults for, advises for, is on the speakers’ bureau for, and received grants from Gilead. He consults for, advises for, and is on the speakers’ bureau for AbbVie, Bayer, Bristol‐Myers Squibb, Eisai, Intercept, and Salix. He consults for, advises for, and is on the data safety monitoring board for Arrowhead. He consults for, advises for, and owns stock in Eiger, Genlantis, and HepQuant. He consults for and advises for Abbott, Access Biologicals, Antios, Dova, Dynavax, Enyo, Forty‐Seven, Fujifilm/Wako, eStudySite, Genentech, Gerson Lehrman, HepaTX, Janssen, Helios, Lilly, Merck, Shionogi, and Viking. He consults for ADMA, AEC, Aligos, Arena, Arterys, Alexion, Altimmune, AprosTx, Cirina, Consumer Health Products Association, DiaSorin, DRG Abacus, DURECT, Echosens, Exelixis, IDLogiq, Intellia, Inotek, Iqvia, KannaLife, Laboratory for Advanced Medicine, Labyrinth Holdings, MedImmune, New Enterprise Associates, Ogilvy, Organovo, Patient Connect, ProdigY Biotech, Prometheus, Refuah Solutions, Regulus, Spring Bank, and Trimaran. He advises for Biocollections, Prodigy, and Quest. He owns stock in RiboSciences, CoCrystal, and AngioCrine.
ORCID 0000-0002-3030-860X
0000-0002-8923-2806
0000-0001-6306-3189
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Snippet Background and Aims Although prevalence of chronic hepatitis B (CHB) in the USA includes 0.42 million (range, 0.28‐0.67) U.S.‐born persons, foreign‐born (FB)...
Although prevalence of chronic hepatitis B (CHB) in the USA includes 0.42 million (range, 0.28-0.67) U.S.-born persons, foreign-born (FB) persons contribute a...
Background and AimsAlthough prevalence of chronic hepatitis B (CHB) in the USA includes 0.42 million (range, 0.28‐0.67) U.S.‐born persons, foreign‐born (FB)...
Although prevalence of chronic hepatitis B (CHB) in the USA includes 0.42 million (range, 0.28-0.67) U.S.-born persons, foreign-born (FB) persons contribute a...
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SubjectTerms Emigrants and Immigrants - statistics & numerical data
Hepatitis
Hepatitis B
Hepatitis B surface antigen
Hepatitis B virus - isolation & purification
Hepatitis B, Chronic - blood
Hepatitis B, Chronic - epidemiology
Hepatology
Humans
Immigration
Original
Prevalence
Seroepidemiologic Studies
Serology
Sex differences
Title An Updated Assessment of Chronic Hepatitis B Prevalence Among Foreign‐Born Persons Living in the United States
URI https://onlinelibrary.wiley.com/doi/abs/10.1002%2Fhep.31782
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