Factors associated with hepatitis B serologic screening in a population- based survey of Korean Americans from Washington state Adeena Khan, MD 1 Genji.

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Factors associated with hepatitis B serologic screening in a population- based survey of Korean Americans from Washington state Adeena Khan, MD 1 Genji S. Terasaki, MD 2, Joon-Ho Yu 2,3, MPH, PhD, John Choe, MD, MPH 2 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 Healthcare Access: Health insurance Regular PCP Single Site of Care Communication: English Proficiency Need Interpreter Ethnic concordance with PCP Hepatitis B testing

Methods: Study Design Population Based Questionnaire of Korean Americans between 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 < > (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%) 255 (55%) 79 (17%)

Results: communication

Results: Access

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 FactorsAssociation with Hep B testing OR (95% CI) One doctor0.89(0.41, 1.92) Interpreter needed1.35(0.68, 2.67) One healthcare location1.50(0.39, 6.02) Age0.97(0.50, 1.90) English proficiency0.78(0.56, 1.10) Percentage of life in U.S. (quintiles) <22% 22-36% 36-45% 45-55% >55% REF (0.18, 1.01) (0.20, 1.10) (0.11, 0.69) (0.08, 0.60)

Proportion of Life in U.S. FactorsAssociation with Hep B testing OR (95% CI) One doctor0.89(0.41, 1.92) Interpreter needed1.35(0.68, 2.67) One healthcare location1.50(0.39, 6.02) Age0.97(0.50, 1.90) English proficiency0.78(0.56, 1.10) Percentage of life in U.S. (quintiles) <22% 22-36% 36-45% 45-55% >55% REF (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 CI 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 Studies Health 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)