title: Evidence for the insufficient evaluation and undertreatment of chronic hepatitis B infection in a predominantly low-income and immigrant population.
abstract: OBJECTIVE
  Many physicians remain unaware of contemporary treatments for chronic hepatitis B (HBV) infection and do not treat their HBV-infected patients or refer them for treatment. The aim of the present study was to determine the rates of laboratory evaluation and treatment of HBV infection in a predominantly low-income and immigrant population.
  
  
  METHODS
  We identified adult patients who tested positive for hepatitis B surface antigen between 1 January 1994 and 30 April 2006. We reviewed patients' medical records to determine two outcomes: (i) receipt of pretreatment evaluation of HBV infection; and (ii) receipt of HBV treatment. We then examined clinical and demographic factors associated with these outcomes.
  
  
  RESULTS
  Twenty-eight percent of 1231 HBV surface antigen-positive patients received additional laboratory evaluation of their infection. In a multivariate analysis, receipt of a HBV evaluation was independently associated with (P < 0.05) female sex, longer duration of HBV infection, more visits to a gastroenterology clinic and less recent health-care contact. Data on treatment were available for 56% of patients; among these, 16% received HBV treatment. In the multivariate analysis, receipt of HBV treatment was independently associated with (P < 0.05) HIV co-infection, receipt of liver biopsy, testing for hepatitis B e antigen or HBV DNA, longer duration of HBV infection, more visits to a gastroenterology clinic and more recent health-care contact. When excluding HIV-infected patients, only 10% of patients received HBV treatment.
  
  
  CONCLUSIONS
  After the diagnosis of HBV infection, few patients in our population received laboratory evaluation to determine eligibility for HBV treatment. Furthermore, only a small percentage received HBV treatment. Further research needs to be done to validate these findings in other populations and understand barriers to receiving HBV treatment.
authors.affiliation: Harbor-UCLA Medical Center, Torrance, California, USA.
authors.forename: Chin W
authors.initials: CW
authors.lastname: Jung
authors.forename: Jennifer
authors.initials: J
authors.lastname: Tan
authors.forename: Nelly
authors.initials: N
authors.lastname: Tan
authors.forename: Melissa N
authors.initials: MN
authors.lastname: Kuo
authors.forename: Ashwin
authors.initials: A
authors.lastname: Ashok
authors.forename: Samantha J
authors.initials: SJ
authors.lastname: Eells
authors.forename: Loren G
authors.initials: LG
authors.lastname: Miller
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D001706:Biopsy; D002140:California / Q000453:epidemiology; D004279:DNA, Viral / Q000097:blood; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011203:Poverty / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014779:Virus Replication
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens