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Meta-Analysis
. 2021 Aug;74(2):607-626.
doi: 10.1002/hep.31782. Epub 2021 May 26.

An Updated Assessment of Chronic Hepatitis B Prevalence Among Foreign-Born Persons Living in the United States

Robert J Wong  1   2 , Carol L Brosgart  3 , Sue Welch  4 , Tim Block  5   6 , Mark Chen  4 , Chari Cohen  5   6 , W Ray Kim  1 , Kris V Kowdley  7 , Anna S Lok  8 , Naoky Tsai  9 , John Ward  10 , Steven S Wong  4 , Robert G Gish  5
Affiliations
Meta-Analysis

An Updated Assessment of Chronic Hepatitis B Prevalence Among Foreign-Born Persons Living in the United States

Robert J Wong et al. Hepatology. 2021 Aug.

Abstract

Background and aims: Although prevalence of chronic hepatitis B (CHB) in the USA includes 0.42 million (range, 0.28-0.67) U.S.-born persons, foreign-born (FB) persons contribute a substantially larger number to the burden of CHB in the USA. Over the past decade, patterns of U.S. immigration have changed and many countries have implemented HBV prevention programs. This study aims to estimate the number of FB persons with CHB in the USA by country of origin, updating our 2011 study.

Approach and results: We performed systematic searches for articles published in 2009-2019 reporting HBsAg seroprevalence in emigrants and in-country populations of 117 countries. Data meeting inclusion criteria were combined with data from our 2011 study to calculate pooled prevalence estimates for 99 countries using meta-analyses (total 2,800 surveys involving 112 million subjects). Combining country-specific CHB rate estimates with the number of FB in the USA in 2018, by country of origin from the U.S. Census Bureau, we estimate that the number of FB with CHB in the USA in 2018 was 1.47 million (95% CI, 1.21-1.73), substantially higher than previously reported. The weighted average CHB prevalence for all FB in the USA in 2018 was 3.07%. Approximately 59% of FB with CHB in the USA in 2018 emigrated from Asia, 19% from the Americas, and 15% from Africa. Subgroup analyses found that for many countries, CHB rates are higher in males than females and have declined over the past three decades, but no consistent pattern is observed between emigrant and in-country rates.

Conclusions: Including FB and U.S.-born persons, the total prevalence of CHB in the USA may be as high as 2.4 million.

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Figures

FIG. 1
FIG. 1
Flowchart of PubMed searches and study selection for 2019 systematic review (aggregate results for 99 country‐specific searches).
FIG. 2
FIG. 2
FB populations living in the USA and number of FB with CHB living in the USA from RE meta‐analysis by world region of origin, 2018. *Northern America = FB from Canada and Bermuda living in the USA.
FIG. 3
FIG. 3
Number of FB persons with CHB living in the USA: comparison of estimates. *Northern America = FB from Canada and Bermuda living in the USA.
See this image and copyright information in PMC

References

    1. U.S. Census Bureau . American Community Survey 1‐Year Public Use Microdata Sample (PUMS) Files 2018. Variables Place of birth and decade of entry. Suitland, MD: U.S. Census Bureau; 2019.
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    1. Kowdley KV, Wang CC, Welch S, Roberts H, Brosgart CL. Prevalence of chronic hepatitis B among foreign‐born persons living in the United States by country of origin. Hepatology 2012;56:422‐433. - PubMed

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