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1 The Hepatitis B Project of Maryland. Mark Li, MD Presented at the Asian American National Health Summit, San Jose, 9-15-2006 Research Data By University.

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Presentation on theme: "1 The Hepatitis B Project of Maryland. Mark Li, MD Presented at the Asian American National Health Summit, San Jose, 9-15-2006 Research Data By University."— Presentation transcript:

1 1 The Hepatitis B Project of Maryland. Mark Li, MD Presented at the Asian American National Health Summit, San Jose, Research Data By University of Maryland Prof. Edward Hsu, Louis Liu MA

2 2 Prevalence of HBV Infections by Race/Ethnicity Chronic HBV infection rates in Non-Hispanic White (0.1%), Hispanic (0.1%), and African-Americans (0.5%): Versus Chronic HBV infection rate in Asian Americans and Pacific Islanders (AAPI) 7%: – Non US-born AAPI: 9% – US-born AAPI: 1.5% Data source: Stanford Asian Liver Center.

3 3 National Statistics of HBV AAPI account for 1/2 of the 1.3 million chronic hepatitis B cases. AAPI accounted for Half of the deaths resulted from chronic hepatitis B infection in the US. AAPI are 3 to 13 times more likely to die from liver cancer than Caucasians – Chinese American at 6 times higher risk – Korean Americans at 8 times, – Vietnamese Americans at 13 times.

4 4 Education, Research and Service The importance of involving Primary care Physicians

5 5 Purposes of Hepatitis B Project Implement a Hepatitis B program in Asian communities of Montgomery County, MD to provide health education to both healthcare providers and the public, obtain more recent statistics by blood screening and to provide free vaccines to residents ages Sponsored by Department of Health and Human Services, Montgomery County, MD Asian Liver Center, Stanford University The Asian American Physician Alliance in Maryland Department of Public and Community Health, University of Maryland The American Cancer Society Community-based Organizations (e.g., the CCACC, KCC, MVMA, and others) Faith-based organizations (Church, Temple, etc.) Other private organizations Quest Diagnostics

6 6 Objectives To raise the public awareness of the health disparities between Asian American communities and their racial counterparts in terms of hepatitis B-related morbidity and mortality. – Establish baseline data of prevalence rate among Asian communities in Montgomery County, MD – Provide education to health providers and the public – Pretest and post tests to measure the effectiveness of public education on the public awareness and the knowledge related to HBV Infection – Provide free screening to 1000 Asian Americans residing in Montgomery County, Maryland – Give free vaccines to Asian Americans who received blood screening and are unprotected ( aged between 18 to 35 )

7 7 EDUCATION TO AAPA Hepatitis B Education to Healthcare providers by participation Lectures and roundtable discussion held by national and local leaders from Michigan, NIH, Miami, Philadelphia, New York, Johns Hopkins University, Georgetown University

8 8 Methods Hepatitis B Education slide show (developed by the Asian Liver Center) 1. Pre test 2. Educational slide presentation 3. Post test Hepatitis B Screening 1. Blood drawing 2. Notify subjects about results and follow up 3. Free vaccine (to eligible participants) 4. Free consultations

9 9 Survey Instrument I: Demographics 1. Gender 2. Age 3. Marital Status 4. Race/ethnicity 5. Years living in the US 6. Education Level 7. Household Income 8. Employment Status 9. Health Insurance Status 10. Montgomery County Residence

10 10 Survey Instrument II: Questionnaire (True/False) 1. Hepatitis B can be passed on from mother to child during childbirth 2. One can be infected with Hepatitis B by sharing food 3. About 10% of the Asian Americans populations are infected with Hepatitis B 4. The majority of chronic Hepatitis B patients has no symptoms 5. Hepatitis B infection cannot be cured, but the disease can be managed 6. Hepatitis B virus is significantly more contagious than HIV 7. Chronic hepatitis B causes liver cancer and cirrhosis if not properly managed 8. Asian Americans have the same risk of dying of liver cancer as their White counterparts 9. Twenty percent of liver cancer is caused by Hepatitis B 10. It is safe to breast-feed even if the mother is infected with Hepatitis B

11 11 Outreach Activities: 10 + events 1. 06/25/06: Asian Indian Temple (17110 New Hampshire Ave, Silver Spring, MD) 2. 04/29/06: Korean Global Mission Church (13421 Georgia Ave. Silver Spring, MD 20906) 3. 04/16/06: Cambodian Buddhist Temple (13800 New Hampshire Ave, Silver Spring, MD) 4. 03/26/06: Korean Global Mission Church (13421 Georgia Ave. Silver Spring, MD 20906) 5. 03/11/06: Taiwanese Presbyterian Church (Newport Mill Rd. & Church Lane, Wheaton, MD 20902) 6. 02/18/06: Hampshire View Baptist Church (360 Ednor Rd. Silver Spring, MD 20905) 7. 02/18/06: Thai Temple, Wat Thai Washington DC, Aspen Hill Rd, MD 8. 01/21/06: Korean Global Mission Church (13421 Georgia Ave. Silver Spring, MD 20906) 9. 12/11/05: The Vietnam Catholic Church (11814 New Hampshire Ave. Silver Spring, MD 20904) /10/05: Capital Chinese Church (810 University Blvd. West, Wheaton, MD 20902) 11. Physician Offices

12 12 Preliminary Results I: Hepatitis B Prevalence (Race/Ethnicity) Group1-Immuned2-Carrier3-UnprotectedTotal Asian Indian 27(30.%)062 (69.7%)89 Cambodian 17(41.5%)3 (7.3%)21 (51.2%)41 Chinese 108(44.8%)13 (5.4%)120 (49.8%)241 Filipino 10(41.7%)1 (4.2%)13 (54.2%)24 Korean 105(52.5%)8 (4.0%)87 (43.5%)200 Taiwanese 40(75.5%)1 (1.9%)12 (22.6%)53 Thai 15(36.8%)3 (7.3%)23 (56.1%)41 Vietnamese 58(53.7%)7 (6.5%)43 (39.8%)108 Other* 0010 Total 380 (47.1%)36 (4.5%)391 (48.5%)807 *Other includes: Indonesian, Malaysian, Sri Lanka, etc. Data as of 07/31/2006.

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15 15 Preliminary Results II: Hepatitis B Prevalence (Age) Age1-Immuned2-Carrier3-UnprotestedTotal 18~25 74(57.8%)2 (1.6%)52 (40.6%)128 26~35 82((45.8%)5 (2.8%)92 (51.4%)179 36~45 33(37.5%)8 (9.1%)47 (53.4%)88 46~55 58(42.6%)9 (6.6%)69 (50.7%)136 56~65 80(51%)8 (5.1%)69 (43.9%) (42.8%)3 (3.1%)53 (54.1%)98 NA Total 380 (47.1%)36 (4.46%)391 (48.5%)807 Source: Quest Laboratory. Data prepared by Louis Liu, University of Maryland. (Data as of: 07/31/06)

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17 17 Preliminary Results III: Hepatitis B Prevalence (By Residence History) Residence history 1-Immuned2-Carrier3-UnimmunedTotal Born in the US 21 (47.7%)024 (53.3%)45 Less than 1 year 11 (47.8%)012 (52.2%)23 1 ~ 4 years 29 (55.8%)1 (1.9%)22 (42.3%)52 5 ~ 9 years 47 (46%)4 (3.9%)51(50%) years or more 195 (44.6%)26 (5.9%)216 (49.4%)437 NA 775 (3.4%)66148 Total 380 (47.1%)36 (4.46%)391(48.5%)807 Source: Quest Laboratory. Data prepared by Louis Liu, University of Maryland. (Data as of: 07/31/06)

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19 19 Preliminary Results IV: Hepatitis B Prevalence (By Education) Education1-Immuned2-Carrier3-UnimmunedTotal High School Diploma or Lower 120(48.8%)15 (6.09%)111(45.1%)246 Vocational Training 21(46.7%)3 (6.67%)21(46.7%)45 Bachelor Degree 111(46%)7 (2.9%)123(51%)241 Master Degree or Higher 43(37.4%)6 (5.22%)66(57.4%)115 NA 855 (3.13%)70160 Total 380(47.1%)36(.46%)391(48.5%)807

20 20 Preliminary Results V: Hepatitis B Prevalence (By Income) Income1-Immuned2-Carrier3-UnimmunedTotal Less than $10,000 60(47.2%)6 (4.72%)61(48%)127 $10,000 ~ $30,000 54(42.5%)8 (6.30%)65(51.2%)127 $30,000 ~ $50,000 66(46.8%)10 (7.09%)65(46.1%)141 $50,000 ~ $70,000 36(48.6%)038(51.4%)74 $70,000 or more 50(40%)5 (4%)70(56%)125 NA 1147 (3.29%)92213 Total 380(47.1%)36(4.46%)391(48.5%)807

21 21 Preliminary Results VI: Hepatitis B Prevalence (By Insurance) Insurance1-Immuned2-Carrier3-UnimmunedTotal Insured/Medicare 19(39.6%)1 (2.08%)28(58.3%)48 Insured/Medicaid 2(33.3%)1 (16.67%)3(50%)6 Insured/Private 23(39%)3 (5.08%)33(56%)59 Insured/Other 139(45.7%)11 (3.62%)154(50.7%)304 Not Insured 104(49.5%)12 (5.71%)94(44.%)210 NA 938 (4.44%)79180 Total 380(47.1%)36(4.46%)391(48.5%)807

22 22 Pre- and Post-test Score (race) ObservationPre-test (SD)Post-test (SD)T-statsP-value Asian Indian66 (11.15%)0.554 (0.189)0.720 (0.159)-5.28< Cambodian39 (6.59%)0.576 (0.171)0.895 (0.147)-8.63< Chinese202 (34.12%)0.673 (0.165)0.921 (0.106)-17.53< Filipino24 (4.05%)0.617 (0.158)0.938 (0.117)-7.72< Korean103 (17.40%)0.665 (0.156)0.897 (0.129)-11.49< Taiwanese40 (6.76%)0.735 (0.158)0.955 (0.093)-7.52< Thai28 (4.73%)0.543 (0.117)0.775 (0.169)-5.90< Vietnamese75 (12.67%)0.634 (0.206)0.769 (0.198)-3.89< Other15 (2.53%)0.553 (0.233)0.807 (0.284) Total592 (100%)0.640 (0.178)0.866 (0.882)-22.49< 0.001

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24 24 Pre- and Post-test Score (age) observationsPre-testPost-testT-statP-value NA55 (9.58%)0.640 (0.150)0.924 (0.129)-10.78< ~25106 (17.91%)0.654 (0.174)0.875 (0.141)-9.79< ~35123 (20.77%)0.669 (0.154)0.888 (0.145)-11.27< ~4558 (9.80%)0.606 (0.189)0.859 (0.184)-7.03< ~5598 (16.55%)0.624 (0.198)0.838 (0.187)-7.60< ~6599 (16.72%)0.638 (0.179)0.843 (0.166)-8.07< above53 (8.95%)0.610 (0.210)0.842 (0.171)-5.98< Total592 (100%)0.640 (0.178)0.866 (0.882)-22.49< 0.001

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26 26 Discussion I: generally consistent with the literature The literature suggests: Vietnamese Americans, Korean Americans and Chinese Americans have high rate of hepatitis B infection In the present study, Cambodian (7.3%) and Thai (7.3%) both have the highest prevalence of carriers. Followed by Vietnamese (6.5%), Chinese (5.7%), and Korean (4.0%).

27 27 Discussion II: new findings from the study Prevalence of HepB in API: The literature indicates that the prevalence of HepB carrier in Asian countries is 10%, in API is 7%, in non US-born API is 9%. The present study suggests that the average infection rates across 8 Asian American groups is 4.5% in non US-born Asian Americans is 5.04%.

28 28 Discussion III: new findings from the study Unprotected rates: highest unprotected rates occurred in Asian Indian group (70%), followed by Thai (56%), Filipino (54%), Cambodian (51%), Chinese (50%), and Korean (44%). Immunized rates: Taiwanese community has the highest immunized rate (75%), followed by Vietnamese (54%) and Korean (53%) communities.

29 29 Important Messages The case of Cambodian/Thai community – high carrier rate and high unimmunized rate. The Asian Indian group – high unimmunized rate. new immigrants seems to have a lower infection rate.

30 30 Limitations and Potential Bias I The attraction of the project is to give free vaccinations to the age group residing in Montgomery County, MD. The residents are affluent and have good medical care. Many have already been screened. The known carriers do not participate Higher younger age group (38%) participated Higher income (15% earns $70,000 +) participated Higher educational levels ( 44% College or higher) participated.

31 31 Limitations and Potential Bias II Budget is limited Most organizers and workers are volunteers Outreach programs available only in weekends when many Asian workers earn their income.

32 32 Limitations and Potential Bias III Maryland has strict regulation in blood drawing in public places Outreach programs are done at places for Religious gatherings or at Medical Clinics Most subjects are recruited from faith- based communities Different ethnic group have varied degree of participation

33 33 Conclusion: Asian American community (vs other racial counterparts) has a high HBV prevalence. ( despite the potential bias as mentioned) Screening of API on Hepatitis B identifies the infected and the unprotected There is a high number of API at risk that require vaccinations Education through outreach projects raises the public awareness There are misconceptions on Hepatitis B in the community Education through outreach projects increase the knowledge of Hepatitis B.

34 34 Next Steps More Educational Outreach programs All community members are encouraged to receive blood screening and vaccines from their doctors A project to provide free screening and vaccination to the Asian American College students in Maryland is planned. Concerted efforts by the Asian Communities of the Country to speak in unison to reduce this health disparity


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