Many Asian-American Primary Care Providers Do Not Screen their Asian-American Patients Who Are at Risk for Chronic Hepatitis B

Hepatitis B virus (HBV) is endemic in many Asian countries, and chronic hepatitis B disproportionately affects the Asian-American community, with a prevalence estimated at 10% or higher. Over time, chronic HBV infection can lead to advanced liver disease, and Asian-American patients are 2.7 times more likely to develop hepatocellular carcinoma (HCC) than Caucasian Americans.

The aim of the current study, presented by Danny Chu at the 13th International Symposium on Viral Hepatitis and Liver Disease (ISVHLD) this week in Washington, DC, was to survey HBV screening practices and barriers to screening of Asian-American primary care providers (PCPs) who treat Asian adults living in the U.S. The meeting included plenary sessions each morning that provided comprehensive state-of-the-art overviews of the 5 known human hepatitis viruses: A, B, C, D, and E.

Approximately 15,000 primary care providers (internists, family practitioners, general practitioners) with Asian surnames living in New York City, Los Angeles, San Francisco, and Houston were invited to participate in a web-based survey during the third quarter of 2008.

Asian-American PCPs with at least 25% Asian-American patients in their practice were eligible for the study. The survey collected demographic information about the providers and their patients, as well as provider HBV knowledge and screening practices.

Results

Of 430 initial respondents, 286 met study eligibility criteria and 233 completed the survey.

65% of the survey respondents were men, 52% were between 41 and 60 years of age.

51% had practiced in the U.S. for more than 10 years and 17% had done so for more than 20 years.

63% were internists and 34% were family practitioners.

87% foreign born, and 48% graduated from foreign medical schools.

More than 50% of practitioners cared for 200 or more Asian-American patients, most of whom were born outside the U.S.

Although 95% of Asian-American PCPs report ever having screened a patient for HBV, 40% reported that 25% or less of their Asian-American patients had ever been screened.

More than 75% of Asian-American PCPs reported diagnosing 10 or fewer patients with HBV in the past year.

More than 40% had diagnosed 1-5 Asian-American adults with HCC during the past year.

80% of PCPs reported that they do not routinely screen all patients for HBV, and 50% do not routinely screen all Asian-American patients.

The most important reasons reported for HBV screening in Asian-American patients were elevated liver enzymes (26%), elevated liver function test plus family history of chronic hepatitis B or liver disease (21%), and birth outside the U.S. (18%).

The most common reasons for not screening for HBV were a perception that the patient is not at risk (23%), lack of symptoms of chronic hepatitis B or liver disease (16%), HBV vaccination (15%), and lack of insurance (13%).

Based on these findings, the researchers concluded, "Although chronic hepatitis B disproportionately affects Asian-Americans, many such patients followed by Asian-American primary care providers are not perceived as being at risk for chronic hepatitis B by their doctor and are not screened."

Further, the investigators stated that more education about the health risks of HBV is needed to improve awareness and diagnosis of chronic hepatitis B in Asian-American patients. They also recommended implementation of the latest HBV screening and management guidelines from the U.S. Centers for Disease Control and Prevention (CDC).

Albert Einstein College of Medicine, New York, NY; University of Michigan Medical Center, Ann Arbor, MI; Geffen UCLA School of Medicine, Cedars Sinai Medical Center, Los Angeles, CA; Mayo Clinic College of Medicine, Rochester, MN; Gilead Sciences, Inc., Durham, NC.

3/24/09

Reference
D Chu, ASF Lok, TT Tran, and others. Hepatitis B Virus (HBV) Screening Practices of Asian-American Primary Care Physicians (PCPs) Who Treat Asian Adults Living in the United States. 13th International Symposium on Viral Hepatitis and Liver Disease (ISVHLD). Washington, DC. March 20-24, 2009. Abstract OP-61/330 (Oral).