Hepatitis B and hepatocellular carcinoma screening among Asian Americans: survey of safety net healthcare providers.
BACKGROUND
Physician patterns of screening for hepatitis B (HBV) and hepatocellular carcinoma (HCC) among Asian Americans are not well described.


OBJECTIVE
To describe HBV and HCC screening practices among providers with large Asian American populations.


METHODS
Providers within San Francisco's safety net system were surveyed with respect to HBV and HCC screening practices as well as knowledge, attitudes, and barriers to HCC screening.


RESULTS
Among the 109 respondents (response rate = 72%), 62% were aged >40, 65% female, 24% Asian, 87% primary care providers, and 48% had >25% Asian patients. Only 76% had screened >50% of their Asian patients for HBV and 43% had vaccinated >50% of eligible patients against HBV. Although 94% knew Asians were disproportionately affected by HCC, only 79% had screened for HCC in >50% of their Asian patients with chronic hepatitis B (CHB). A majority believed that HCC screening in CHB reduces HCC mortality (70%) and is cost-effective (57%). The most common HCC screening modality was AFP with abdominal ultrasound every 6-12 months (63%). Factors associated with HBV screening were familiarity with AASLD guidelines (OR 6.4, 95% CI 1.3-30.1, p = 0.02) and having vaccinated >50% of eligible patients against HBV (OR 2.2, 95% CI 1.1-4.5, p = 0.03). Factors associated with HCC screening using abdominal ultrasound every 6-12 months were having >25% Asian patients (OR = 4.5, 95% CI 1.3-15.3, p = 0.02) and higher HCC knowledge score (OR = 1.9 per item, 95% CI 1.01-3.6, p = 0.045).


CONCLUSIONS
HBV and HCC screening rates and HBV vaccination among Asians from physician report is suboptimal. HCC screening is associated with having more Asian patients and higher provider knowledge. Provider education is essential in increasing rates of HBV and HCC screening among Asian Americans.
Department of Medicine, University of California San Francisco, San Francisco General Hospital, 1001 Potrero Ave, NH-3D, San Francisco, CA 94110, USA. mandana.khalili@ucsf.edu
Mandana
M
Khalili
Jennifer
J
Guy
Albert
A
Yu
Alexander
A
Li
Nadia
N
Diamond-Smith
Susan
S
Stewart
Moon
M
Chen
Tung
T
Nguyen
D000328:Adult; D001213:Asian; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000453:epidemiology; D003625:Data Collection; D055088:Early Detection of Cancer; D005260:Female; D006509:Hepatitis B / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D017325:Hepatitis B Vaccines / Q000276:immunology; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
D017325:Hepatitis B Vaccines