Liver Diseases in South Korea: A Pulse Check of the Public's Knowledge, Awareness, and Behaviors

Abstract

Purpose: National surveys in Korea have spotlighted suboptimal levels of awareness among the public towards liver-related health and diseases, leading to progressive reform of national policies and education efforts. This study aimed to assess the status of the Korean public's knowledge towards liver-related diseases.

Materials and methods: A self-reported, cross-sectional, web-based questionnaire study was conducted between February-March 2020 among 1000 Korean adults. Questionnaire items assessed the knowledge, awareness, and behaviors towards liver-related health and diseases.

Results: About half (50.9%-52.1%) knew untreated/chronic viral hepatitis could lead to liver failure and/or cancer. Misconceptions pertaining to viral hepatitis transmission risks exist with only 26.3% knowing viral hepatitis B cannot be transmitted by dining with an infected individual. About one-fifth (22.2%) were aware of an available cure for viral hepatitis C. Less than half were aware of the risk factors associated with nonalcoholic steatohepatitis (NASH), despite 72.4% and 49.5% having heard of fatty liver disease and NASH, respectively. More than one-third were unlikely to seek medical consultation even if exposed to viral hepatitis risk factors or upon diagnosis with a liver condition. Reasons for this low urgency included costs-related concerns, perceptions of being healthy, and the viewpoint that the condition is not life-threatening.

Conclusion: The public's knowledge towards liver-related diseases in Korea was found to be lacking, which could account for a lower sense of urgency towards screening and treatment. More efforts are needed to address misperceptions and dispel stigma in an effort to encourage pro-health seeking behaviors.

Keywords: Hepatitis B; awareness; hepatitis C; knowledge; nonalcoholic fatty liver disease.

Fig. 1. Knowledge and awareness of Korean adults towards the features of (A), diagnostic test or treatment (B), and the transmission risks of (C) viral hepatitis B and C. Correct responses are indicated in brackets, unless otherwise indicated. ^*Correct responses for “...preventable by vaccination“ are “agree” for hepatitis B and “disagree” for hepatitis C, respectively.

Fig. 2. Awareness and knowledge of adult Koreans towards fatty liver disease (A) and the associated risk factors of nonalcoholic fatty liver disease (B). ^*Multiple responses were allowed to the question; ^†Including excessive alcohol consumption. AF-NASH, advanced fibrosis nonalcoholic steatohepatitis; ALT, alanine aminotransferase; AST, aspartate aminotransferase.

Fig. 3. Reasons perceived by Korean adults for not attending health screening or undergoing treatment upon diagnosis with viral hepatitis. (A) Reasons for not attending screening. (B) Timing of treatment initiation post-diagnosis of liver condition. (C) Reasons for not receiving treatment from a hospital/clinic. ^*Multiple responses were allowed.

Fig. 4. Comparison of awareness towards knowledge of liver diseases in 2020 and 2013–2019. HBV, hepatitis B virus; HCV, hepatitis C virus; NAFLD, nonalcoholic fatty liver disease; NASH, nonalcoholic steatohepatitis.