Researchers Document Lack of Hepatitis B Screening in High Risk Groups
1457. Screening for Hepatitis B Virus (HBV) Infection by Primary Care
Physicians in New York City: Are Screening Recommendations for Persons Born in
Endemic Countries Being Followed?
H. Pollack; K. Wan; T. Miyoshi; G. Fryer; S. Tawdekar; P. Baker; D. McEwen; C.
Weinbaum; S. R. Bialek; R. Low
Screening for hepatitis B virus (HBV) infection is recommended for persons born in regions where hepatitis B is endemic. Current physician practices with respect to screening for chronic HBV infection are largely unknown. In this study we examined screening practices for chronic HBV among primary care clinics in an urban hospital system. De-identified patient information was abstracted from electronic medical records.
We present preliminary results on screening practices for 18,457 patients 19-49 years of age, who first visited primary care clinics in the NYC Health and Hospital's South Manhattan Network (including Bellevue Hospital Center) in New York City during 2005-2006. The patient population consisted of Asian/Pacific
Islanders (26.1%), Blacks (12.7%), Hispanics (42.3%), Native Americans (0.2%), and Whites (7.0%). 69.6% were foreign born.
Among the 18,457 patients, 42.4% (7,826) were screened for HBsAg. 1026 (71.8%) of 1429 persons with elevated ALT were screened for HBsAg compared to 5826 (49.6%) of 11749 with normal ALTs, p=8%), those born in East Asia countries had the highest screening rate (692/1088, 63.6%) followed by Southeast Asia (153/304, 50.3%), and Africa (230/521, 44.1%). Patients born in regions of intermediate HBV endemicity (2-7%) including Eastern Europe, South Asia, Middle East, Central America, South America, and the Caribbean had screening rates of 35.6-40.1%, comparable to rates for patients born in the U.S. (39.5%).
The screening rates varied greatly among individual clinics, highest (1040/1810, 57.5%) at community clinics which served large numbers of APIs and lowest (25/212, 11.8%) at a community clinic which served large numbers of Hispanics.
This pilot study revealed that screening for HBsAg was correlated with elevated ALT, younger age, Asian race and region of birth with HBV epidemic. However, nearly 50% of patients from countries where HBV infection is endemic, and for whom screening is recommended by the CDC, had not been tested. More rigorous efforts will be necessary to increase compliance for HBV screening in this group of patients in order to decrease long-term morbidity and mortality.
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