The viral hepatitis B care cascade: A population‐based comparison of immigrant groups
Autor: | Tony Mazzulli, Jordan J. Feld, Rafal Kustra, Lauren Lapointe-Shaw, Natasha S. Crowcroft, Morris Sherman, Naveed Z. Janjua, Liane Macdonald, Jeffrey C. Kwong, Christina Greenaway, Abdool S. Yasseen, Beate Sander |
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Rok vydání: | 2021 |
Předmět: |
Male
Medication Therapy Management media_common.quotation_subject Immigration Population Emigrants and Immigrants Cohort Studies symbols.namesake Prevalence medicine Humans Mass Screening Hepatitis B e Antigens Poisson regression education Disease burden Retrospective Studies media_common Ontario Health Services Needs and Demand education.field_of_study Hepatitis B Surface Antigens Hepatology medicine.diagnostic_test business.industry Nucleic acid test Retrospective cohort study Viral hepatitis b Continuity of Patient Care Middle Aged Hepatitis B medicine.disease Epidemiological Monitoring symbols Female business Demography |
Zdroj: | Hepatology. 75:673-689 |
ISSN: | 1527-3350 0270-9139 |
Popis: | 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.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 treatment1 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).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. |
Databáze: | OpenAIRE |
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