title: A cross-border comparison of hepatitis B testing among chinese residing in Canada and the United States.
abstract: BACKGROUND
  The Western Pacific region has the highest level of endemic hepatitis B virus (HBV) infection in the world, with the Chinese representing nearly one-third of infected persons globally. HBV carriers are potentially infectious to others and have an increased risk of chronic active hepatitis, cirrhosis, and hepatocellular carcinoma. Studies from the U.S. and Canada demonstrate that immigrants, particularly from Asia, are disproportionately affected by liver cancer.
  
  
  OBJECTIVE
  Given the different health care systems in Seattle and Vancouver, two geographically proximate cities, we examined HBV testing levels and factors associated with testing among Chinese residents of these cities.
  
  
  METHODS
  We surveyed Chinese living in areas of Seattle and Vancouver with relatively high proportions of Chinese residents. In-person interviews were conducted in Cantonese, Mandarin, or English. Our bivariate analyses consisted of the chi-square test, with Fisher's Exact test as necessary. We then performed unconditional logistic regression, first examining only the city effect as the sole explanatory variable of the model, then assessing the adjusted city effect in a final main-effects model that was constructed through backward selection to select statistically significant variables at alpha=0.05.
  
  
  RESULTS
  Survey cooperation rates for Seattle and Vancouver were 58% and 59%, respectively. In Seattle, 48% reported HBV testing, whereas in Vancouver, 55% reported testing. HBV testing in Seattle was lower than in Vancouver, with a crude odds ratio of 0.73 (95% CI = 0.56, 0.94). However after adjusting for demographic, health care access, knowledge, and social support variables, we found no significant differences in HBV testing between the two cities. In our logistic regression model, the odds of HBV testing were greatest when the doctor recommended the test, followed by when the employer asked for the test.
  
  
  CONCLUSIONS
  Findings from this study support the need for additional research to examine the effectiveness of clinic-based and workplace interventions to promote HBV testing among immigrants to North America.
authors.affiliation: Dept of Medicine, University of Washington, Seattle, WA, USA. shinping@u.washington.edu
authors.forename: Shin-Ping
authors.initials: SP
authors.lastname: Tu R
authors.forename: Lin
authors.initials: L
authors.lastname: Li
authors.forename: Jenny Hsin-Chun
authors.initials: JH
authors.lastname: Tsai
authors.forename: Mei-Po
authors.initials: MP
authors.lastname: Yip
authors.forename: Genji
authors.initials: G
authors.lastname: Terasaki
authors.forename: Chong
authors.initials: C
authors.lastname: Teh
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yasui
authors.forename: T Gregory
authors.initials: TG
authors.lastname: Hislop
authors.forename: Vicky
authors.initials: V
authors.lastname: Taylor
mesh_terms: D000328:Adult; D044466:Asian People / Q000706:statistics & numerical data*; D001294:Attitude to Health; D002170:Canada; D006528:Carcinoma, Hepatocellular / Q000208:ethnology / Q000517:prevention & control* / Q000821:virology; D054242:Emigrants and Immigrants; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006509:Hepatitis B / Q000175:diagnosis* / Q000208:ethnology; D006515:Hepatitis B virus / Q000472:pathogenicity*; D006801:Humans; D008103:Liver Cirrhosis / Q000208:ethnology / Q000517:prevention & control* / Q000821:virology; D008113:Liver Neoplasms / Q000208:ethnology / Q000517:prevention & control* / Q000821:virology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011795:Surveys and Questionnaires; D014481:United States