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, 49 (5 Suppl), S28-34

Epidemiology of Hepatitis B in the United States

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Epidemiology of Hepatitis B in the United States

W Ray Kim. Hepatology.

Abstract

Hepatitis B virus (HBV) remains an important cause of acute and chronic liver disease globally and in the United States. An encouraging trend is that the incidence of acute hepatitis B in the United States declined as much as 80% between 1987 and 2004, attributable to effective vaccination programs as well as universal precautions in needle use and in healthcare in general. Although encouraging, these decreases in acute infections have not translated into diminished prevalence or burden of chronic HBV infection. The prevalence for HBV in the United States has been estimated to be approximately 0.4%. However, these estimates have been based on surveys conducted in samples in which population groups with high prevalence of HBV infection, namely foreign-born minorities, were underrepresented. Voluntary screening data indicate prevalence in excess of 15% in some of these groups. Recent immigration trends suggest a substantial increase in the number of Americans with chronic HBV infection. This trend is reflected in the health and economic burden associated with HBV infection. The number of outpatient visits and hospitalizations for a HBV-related diagnosis increased several-fold during the 1990s. Similarly, the total charges for hospitalizations have been estimated to have increased from $357 million in 1990 to $1.5 billion in 2003. Most recent data indicate that death and liver transplant waitlist registration for HBV-related liver disease, which had been increasing, have now reached a plateau or started to decline. This encouraging trend might be attributable to recent advances in treatment for HBV infection; however, to the extent that the number of Americans living with chronic HBV is growing, careful clinical monitoring and continued epidemiologic surveillance remain important.

Conflict of interest statement

Potential Conflicts of Interest:

Grants: None

Consultant (ad hoc and advisory board): Bristol-Myers-Squibb, Gilead Sciences, Roche

Figures

Figure 1
Figure 1
Incidence of acute hepatitis B per 100,000 population in the United States by year (1990–2004) and age group. (Reproduced from reference , permission waived by CDC).
Figure 2
Figure 2
Incidence of acute hepatitis B per 100,000 population (gender adjusted) in the United States by year (1990–2004) and racial group. (Reproduced from reference , permission waived by CDC). Abbreviations: AI/AN, American Indian and Aboriginal Native; API, Asian or Pacific Islander.
Figure 3
Figure 3
Prevalence of HBsAg among 12, 389 refugees arriving in Minnesota between 1998 and 2001 by continent of origin and age group (decade). Overall percentage and numbers tested given in the legend. Data from reference .
Figure 4
Figure 4
Prevalence of HBsAg among Asian-Pacific Islander Populations in New York City by age group. Data from reference .
Figure 5
Figure 5
Number of hospital discharges and total charges (in 2006 adjusted U.S. dollars) with a hepatitis B-related illness in the United States by year (1990–2006). Agency for Healthcare Research and Quality, unpublished data. Error bars indicate the upper half of 95% confidence interval.
Figure 6
Figure 6
Number of patients placed on the liver transplantation waitlist by year for hepatitis B-related indications in the United States. Registrants for end-stage cirrhosis have been declining (−37%) while those for hepatocellular carcinoma (HCC) have been rising (+146%). Data from reference .
Figure 7
Figure 7
Number of in-hospital deaths due to hepatitis B-related causes in the United States by year (1990–2006). Nationwide Inpatient Sample, Agency for Healthcare Research and Quality, unpublished data. Error bars indicate the upper half of 95% confidence interval.

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