Post on 09-Feb-2016
description
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)