BACKGROUND: Studies indicate that most Hepatitis B Virus (HBV)-positive Asians living in the United States are foreign-born and acquired the disease perinatally or through early household contact. Philadelphia’s HBV surveillance findings, however, suggest that while there are Black and White HBV-positive US immigrant populations, most individuals in these racial/ethnic groups become infected after engaging in high-risk behaviors later in life. Differences in disease progression, lack of screening, and cultural and sociological barriers to healthcare may influence the prevalence of HBV-associated outcomes among racial/ethnic groups. This study links HBV surveillance data from the Philadelphia Department of Public Health (PDPH) to cancer registry and death certificate data to assess the impact of race/ethnicity and associated HBV etiology on liver cancer (LC) and mortality.
METHODS: For 2003-2013, HBV surveillance registry data was matched to cancer registry listings and death certificates of Philadelphia residents. A retrospective cohort study comparing HBV outcomes among Asians, non-Hispanic Blacks and non-Hispanic Whites was conducted. Mean age at sentinel event (HBV diagnosis, LC diagnosis, and death) and primary cause of death for individuals with and without HBV were also assessed.
RESULTS: HBV-infected cases who developed LC were more likely to be Asian than Black or White (44% v. 11% and 13%, respectively; p<0.001). Mean age of LC diagnosis and death was similar for HBV-infected Asians and Whites but five years lower for Blacks (p<0.0001). Among HBV-infected cases who died, Asians had a 60% likelihood of dying from LC or liver cirrhosis, as compared with 29% and 40% of Blacks and Whites, respectively (p<0.0001). Another predominant cause of death among Blacks was HIV (20%), and among Whites, HIV (5%) and drug intoxication (10%). Neither was observed among Asians. When HIV deaths were removed, mean age of LC diagnosis was equivalent among all three HBV-infected racial/ethnic groups.
CONCLUSIONS: This study shows an increased prevalence of LC diagnoses among HBV-infected Asians which may be the result of early childhood infection. In contrast, HIV-coinfection and/or drug intoxication among HBV-infected Blacks and Whites suggest more risk-based modes of HBV transmission in these groups. This study highlights the need for rigorous LC screening protocols that target HBV-infected Asians, and HBV awareness and testing campaigns for all populations engaging in high-risk behaviors.