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Hepatitis B and Hepatocellular Carcinoma Screening Practices in Chinese and African Immigrant-Rich Neighborhoods in New York City

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Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

An Erratum to this article was published on 26 January 2017

This article has been updated

Abstract

Background

Immigrants from China and Africa have high rates of hepatitis B virus infection (HBV) and hepatocellular carcinoma (HCC); however, primary care physician (PCP) adherence to screening guidelines in at-risk communities is not well understood.

Methods

The New York City (NYC) neighborhood tabulation areas with the 25 greatest Chinese and African immigrant populations were determined based on US census data. The American Medical Association database was used to identify PCPs practicing in these neighborhoods. A Web-based survey designed to assess HBV and HCC knowledge and screening practices was distributed via e-mail to PCPs in these target areas.

Results

A total of 2072 physicians were contacted, and 109 responded to the survey, for a response rate of 5.3 %. Among responding physicians, 73 % report routinely testing immigrant patients for HBV. However, if a patient tests positive for HBV, only 68 % of providers recommend screening for HCC. Over a quarter of PCPs (27 %), failed to correctly state that antiviral therapy can lower the risk of developing HCC, and only 56 % correctly replied that screening for liver cancer improves survival. Of responders, only 54 % answered correctly that a 25-year-old patient from Africa with HBV should be screened for HCC, whereas 53 % answered incorrectly that a 25-year-old patient from China with HBV should be screened, demonstrating a lack of awareness of the different age of onset of liver cancer in the two groups. The most commonly reported barrier to offering both HBV testing and HCC screening was a “lack of clear guidelines.” Neither HBV nor HCC was among the top 3 health concerns of patients, as perceived by their physicians. There were no significant differences between provider responses in Chinese and African immigrant neighborhoods.

Conclusions

Providers serving Chinese and African immigrants in NYC often fail to recommend appropriate HBV and HCC screening. This appears to be due to significant gaps in provider knowledge and a lack of awareness of established screening guidelines. This study suggests the need for better distribution of existing guidelines to physicians serving immigrant-rich communities in order to improve HBV and HCC screening in high-risk individuals.

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Change history

  • 26 January 2017

    An erratum to this article has been published.

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Authors and Affiliations

  1. Icahn School of Medicine at Mount Sinai, New York, NY, USA

    S Fitzgerald, J Chao, Y Feferman, P Perumalswami & U Sarpel

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  1. S Fitzgerald
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  2. J Chao
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  3. Y Feferman
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  4. P Perumalswami
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  5. U Sarpel
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Corresponding author

Correspondence to U Sarpel.

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Funding

We gratefully acknowledge that this study was supported by grant 1R03CA164546-01A1 from the National Cancer Institute.

Conflict of Interest

Authors Fitzgerald, Chao, Perumalswami, Feferman, and Sarpel declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Please note that this study was determined to have “exempt” status after formal consideration by our Institutional Review Board.

Additional information

The original version of this article was revised: The correct spelling of the third author’s family name is Feferman.

An erratum to this article is available at https://doi.org/10.1007/s40615-016-0331-z.

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Fitzgerald, S., Chao, J., Feferman, Y. et al. Hepatitis B and Hepatocellular Carcinoma Screening Practices in Chinese and African Immigrant-Rich Neighborhoods in New York City. J. Racial and Ethnic Health Disparities 4, 928–935 (2017). https://doi.org/10.1007/s40615-016-0296-y

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  • DOI: https://doi.org/10.1007/s40615-016-0296-y

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