The viral hepatitis B care cascade: A population-based comparison of immigrant groups.

Autor: Yasseen AS; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.; ICES, Toronto, Ontario, Canada.; Public Health Ontario, Toronto, Ontario, Canada., Kwong JC; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.; ICES, Toronto, Ontario, Canada.; Public Health Ontario, Toronto, Ontario, Canada.; University Health Network, Toronto, Ontario, Canada.; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada., Feld JJ; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.; ICES, Toronto, Ontario, Canada.; University Health Network, Toronto, Ontario, Canada.; Department of Medicine, University of Toronto, Toronto, Ontario, Canada., Kustra R; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada., MacDonald L; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.; Public Health Ontario, Toronto, Ontario, Canada., Greenaway CC; Division of Infectious Diseases, Jewish General Hospital, Montreal, Quebec, Canada.; Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Quebec, Canada.; Department of Medicine, McGill University, Montreal, Quebec, Canada., Janjua NZ; British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada., Mazzulli T; Public Health Ontario, Toronto, Ontario, Canada.; University Health Network, Toronto, Ontario, Canada., Sherman M; University Health Network, Toronto, Ontario, Canada., Lapointe-Shaw L; ICES, Toronto, Ontario, Canada.; University Health Network, Toronto, Ontario, Canada.; Department of Medicine, University of Toronto, Toronto, Ontario, Canada., Sander B; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.; ICES, Toronto, Ontario, Canada.; Public Health Ontario, Toronto, Ontario, Canada.; University Health Network, Toronto, Ontario, Canada., Crowcroft NS; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.; ICES, Toronto, Ontario, Canada.; Public Health Ontario, Toronto, Ontario, Canada.
Jazyk: angličtina
Zdroj: Hepatology (Baltimore, Md.) [Hepatology] 2022 Mar; Vol. 75 (3), pp. 673-689. Date of Electronic Publication: 2021 Dec 07.
DOI: 10.1002/hep.32162
Abstrakt: Background and Aims: The global burden of viral hepatitis B is substantial, and monitoring infections across the care cascade is important for elimination efforts. There is little information on care disparities by immigration status, and we aimed to quantify disease burden among immigrant subgroups.
Approach and Results: In this population-based, retrospective cohort study, we used linked laboratory and health administrative records to describe the HBV care cascade in five distinct stages: (1) lifetime prevalence; (2) diagnosis; (3) engagement with care; (4) treatment initiation; and (5) treatment continuation. Infections were identified based on at least one reactive antigen or nucleic acid test, and lifetime prevalence was estimated as the sum of diagnosed and estimated undiagnosed cases. Care cascades were compared between long-term residents and immigrant groups, including subgroups born in hepatitis B endemic countries. Stratified analyses and multivariable Poisson regression were used to identify drivers for cascade progression. Between January 1997 and December 2014, 2,014,470 persons were included, 50,475 with infections, of whom 30,118 were engaged with care, 11,450 initiated treatment, and 6554 continued treatment >1 year. Lifetime prevalence was estimated as 163,309 (1.34%) overall, 115,722 (3.42%) among all immigrants, and 50,876 (9.37%) among those from highly endemic countries. Compared to long-term residents, immigrants were more likely to be diagnosed (adjusted rate ratio [aRR], 4.55; 95% CI, 4.46, 4.63), engaged with care (aRR, 1.07; 95% CI, 1.04, 1.09), and initiate treatment (aRR, 1.09; 95% CI, 1.03, 1.16).
Conclusions: In conclusion, immigrants fared well compared to long-term residents along the care cascade, having higher rates of diagnosis and slightly better measures in subsequent cascade stages, although intensified screening efforts and better strategies to facilitate linkage to care are still needed.
(© 2021 American Association for the Study of Liver Diseases.)
Databáze: MEDLINE
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