Awareness of Chronic Viral Hepatitis in the United States

An Update From the National Health and Nutrition Examination Survey

Hyun-seok Kim; Ju Dong Yang; Hashem B. El-Serag; Fasiha Kanwal

Disclosures

J Viral Hepat. 2019;26(5):596-602. 

In This Article

Abstract and Introduction

Abstract

The World Health Organization has set the goal of reducing the hepatitis-related mortality rate by 65% between 2015 and 2030. Diagnosis and awareness of infection is the first essential step towards achieving this goal. Our study examined the current awareness rate of chronic viral hepatitis in the United States and the potentially associated factors. In the National Health Nutrition and Examination Survey 2013–2016, there were 11 488 persons who participated in serology testing for chronic viral hepatitis. We defined chronic hepatitis B virus (HBV) infection by HbsAg, HBV past exposure by anti-HBc and hepatitis C virus (HCV) infection by HCV RNA. At risk for significant fibrosis was determined by AST to Platelet Ratio Index >0.7. Awareness of chronic HBV infection, past HBV exposure and HCV infection were present in 33.9%, 11.7% and 55.6% of participants, respectively. Among HCV-infected baby boomers, the awareness was in 61.5%. The awareness of HBV infection was significantly higher in individuals with high education level. Age group (40–60 years), women, non-Black race/ethnicity and those with high household income who were born in the United States with insurance plans tend to be aware of their infection. For HCV, awareness was the lowest in Hispanics and Asians, foreign-born who lived below the federal poverty level and low education level. Awareness among chronic viral hepatitis patients at risk for significant fibrosis was 62.0% in HBV and 38.2% in HCV infection. In conclusion, current awareness of chronic viral hepatitis in the United States remains suboptimal. Active public health policy to identify persons at risk and provide appropriate management is warranted.

Introduction

Chronic viral hepatitis, hepatitis B virus (HBV) or hepatitis C virus (HCV) results in more than 1 million deaths annually worldwide and 20 000 deaths in the United States. Collectively, chronic viral hepatitis accounts for more deaths than that from HIV/AIDS, tuberculosis or malaria.[1–3] In 2014, the World Health Organization (WHO) set a goal to reduce the incidence of chronic viral hepatitis by 90% and reduce the mortality rate by 65% between 2015 and 2030.[2]

Diagnosis and awareness of infection is the first essential step towards achieving this goal. Using National Health and Nutrition Examination Survey (NHANES) data from 2002 to 2007, Volk et al[4] found that ~49% of individuals with HCV infection were unaware of their infection. We also reported 26.2% awareness of HBV chronic infection using NHANES 2013–2014 data.[5] Recently, several national initiatives have focused on enhancing screening and diagnosis of chronic viral hepatitis in the United States.[6,7] For example, the Centers for Disease Control and Prevention (CDC) set forth the birth cohort screening recommendation in 2012 for HCV infection.[8] However, the effect of these efforts on the current diagnosis and awareness rate of chronic viral hepatitis in the United States is not fully understood. Lack of these data is one of the key roadblocks in implementing appropriate health policy towards achieving the WHO's goal.[9]

Our study aimed to estimate the current awareness of chronic viral hepatitis and possible factors associated with the awareness, using the nationally representative NHANES data for the most current cycles from 2013 to 2016.

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