Factors associated with hepatitis B serologic screening in a population-based survey of Korean Americans from Washington state

 Adeena Khan, MD1

Genji S. Terasaki, MD2, Joon-Ho Yu2,3, MPH, PhD,

John Choe, MD, MPH2

University of Washington School of Medicine: 1 Internal Medicine Residency

Training Program, 2 Departments of Medicine and 3 Pediatrics

Background: Impact on Asian Patients

• 1.3 million Americans with chronic hepatitis B virus (HBV)

• Health disparity among Asian Americans– ≥50% of all chronic HBV infection are Asian Americans

• Perinatal transmission major risk factor for Asian Americans

• Cirrhosis and hepatocellular carcinoma are late sequelae

Endemic Areas of Infection

Current Testing

Why Test for Hepatitis B?– Prevent transmission, encourage vaccination– Behavior modification– Treat with antivirals– Screen for sequelae

Study Question

• Korean Americans and Hepatitis B testing

• Predictors of Hepatitis B testing– Asian American subgroups

• Hypothesis– We hypothesized that factors related to communication

and access to medical care would serve as barriers of facilitators of having had prior HBV testing

Methods: Questionnaire

Methods: Study Design• Population Based Questionnaire of Korean Americans

between 18-64 years of age• Questions:

– Demographics– Communication– Access to Care– Hep B knowledge– Hep B testing

• Bilingual and bicultural field interviewers conducted in-person surveys in homes

Results: Demographics N = 466

Age <35 35-49 >49

100 (22%)223 (48%) 142 (31%)

Marital Status Married Previously married Never married

385 (83%)25 (5%)

55 (12%)Birth Country S. Korea N. Korea US

448 (98%)3 (1%)4 (1%)

Education <12 12-16 >16

131 (12%)255 (55%)79 (17%)

Results: communication

Proportion Life in U.S.

<1/31/3-2/3>2/3

Need Interpreter

YesNo

Results: Access

One Doctor

YesNo

Medical Insurance

YesNo

Results: Analysis

• Bivariate association– Access factors not associated with HBV testing– Communication factors also not associated– Trend toward association with one site of medical care (p = 0.07)

Results: Multivariate Regression

Factors Association with Hep B testing OR (95% CI)

One doctor 0.89 (0.41, 1.92)

Interpreter needed 1.35 (0.68, 2.67)

One healthcare location 1.50 (0.39, 6.02)

Age 0.97 (0.50, 1.90)

English proficiency 0.78 (0.56, 1.10)

Percentage of life in U.S. (quintiles) <22% 22-36% 36-45% 45-55% >55%

REF0.430.470.270.22

--(0.18, 1.01)(0.20, 1.10)(0.11, 0.69)(0.08, 0.60)

Proportion of Life in U.S.

Factors Association with Hep B testing OR (95% CI)

One doctor 0.89 (0.41, 1.92)

Interpreter needed 1.35 (0.68, 2.67)

One healthcare location 1.50 (0.39, 6.02)

Age 0.97 (0.50, 1.90)

English proficiency 0.78 (0.56, 1.10)

Percentage of life in U.S. (quintiles) <22% 22-36% 36-45% 45-55% >55%

REF0.430.470.270.22

--(0.18, 1.01)(0.20, 1.10)(0.11, 0.69)(0.08, 0.60)

Summary

• Health care and linguistic access were not associated with testing

• As proportion of life in US increases, there is decreased self reported hepatitis B testing

••

Limitations and Strengths

• Cross sectional study

• Self reported testing

• Population based Study

• Bicultural interviews

Recent Immigrants: more testing

Theories:

• Health programs target most recent arrivals

In this population based study, factors related to communication and access were not associated with HBV testing

Koreans who have been living longest in the US were least likely to report having had HBV serologic testing

Recent Immigrants: more testing

Theories:

• Health Programs target most recent arrivals

• Subject to reporting

In this population based study, factors related to communication and access were not associated with HBV testing

Koreans who have been living longest in the US were least likely to report having had HBV serologic testing

Recent Immigrants: more testing

Theories:

• Health Programs target most recent arrivals

• Subject to reporting

• Provider Bias

In this population based study, factors related to communication and access were not associated with HBV testing

Koreans who have been living longest in the US were least likely to report having had HBV serologic testing

Implications

• Immigrants in the U.S. longer at greatest risk, increased need for targeted attention

• Increased need for focus for this group in Primary care

Acknowledgements

• Vicky Taylor• Beti Thompson• Jeffrey Harris• Shin-Ping Tu

• Carey Jackson• Scott Ramsey• Yutaka Yasui• Roshan Bastani

Community Advisory Board members and supporting community organizations

CDC Health Promotion Research Initiative – K01 CI000302

National Cancer Institute and the Asian American Network for Cancer Awareness, Research and Training (AANCART)

Robert Wood Johnson Foundation Physician Faculty Scholars Program

Methods

• Participants identified by surname from electronic database of telephone number

• Three counties in Western Washington State• Bilingual and bicultural field interviewers

conducted in-person surveys in homes• Survey developed by adapting questionnaire

previously used in Chinese and Vietnamese American communities

• Previous qualitative research

Other StudiesHealth care access and sociodemographic factors associated

with hepatitis B testing in Vietnamese American men (Choe, Taylor)

-Shorter time in U.S. was associated with hepatitis B testing (bivariate analysis)

Hepatitis B Knowledge, Testing and Vaccination Levels in Chinese Immigrants to British Columbia, Canada (Hislop, Tu)

-Hep B testing associated with shorter time in North America (bivariate analysis)