Chronic Hepatitis B Prevalence Among Foreign‐Born and U.S.‐Born Adults in the United States, 1999‐2016

Hepatitis B virus (HBV) infection remains a major global health problem, exacerbated by poor linkage to care. We aimed to determine the prevalence of HBV infection, exposure, self‐reported vaccination, vaccine‐induced immunity, disease awareness, and treatment in the United States by birthplace and race/ethnicity during 1999‐2016. A total of 47,628 adult participants in the National Health and Nutrition Examination Survey who completed HBV core antibody (anti‐HBc) and surface antigen (HBsAg) tests and 47,618 adults who completed HBV surface antibody (anti‐HBs) and anti‐HBc tests were included in the analysis. HBV infection was defined by positive HBsAg and past exposure by positive anti‐HBc. Vaccine‐mediated immunity was defined by positive anti‐HBs and negative anti‐HBc. No significant change in the prevalence of HBV infection was observed between 1999 and 2016 (P = 0.442), affecting 0.35% (95% confidence interval [CI], 0.28‐0.45) or 0.84 million adults. In contrast, a significant decrease in HBV exposure and increase in vaccine‐mediated immunity was observed. U.S.‐born persons had significantly lower prevalence of HBV infection and exposure as well as higher prevalence of vaccine‐mediated immunity and self‐reported vaccination than foreign‐born persons. Prevalence of HBV infection was highest in non‐Hispanic Asians in both foreign‐ (3.85%; 95% CI, 2.97‐4.97) and U.S.‐born (0.79%; 95% CI, 0.17‐3.59) persons during 2011‐2016. Among infected persons, liver disease awareness was only 15.19%, and treatment rate was only 4.60%. Conclusion: This study revealed disparities of HBV infection among ethnic/racial groups and between U.S.‐born and foreign‐born persons. Awareness of liver disease and treatment rate among infected persons was dismal.