Hepatitis B In AAPI Communities: Risks, Barriers, and Resources

The liver is one of the most important parts of your body. It serves vital roles such as filtering blood that’s passing through your stomach and intestines, detoxifying and metabolizing chemicals, and making proteins important for various functions like blood clotting. 

Hepatitis is defined as inflammation of the liver, which can prevent it from effectively performing its important duties. The most common cause of hepatitis in the U.S. is infection due to viruses — such as the hepatitis B virus. But, liver damage can also be caused by drinking too much alcohol, poisonous toxins, certain medications, and other medical conditions. 

In this article, we will focus on hepatitis B and why it may be more common in particular groups, such as the Asian American and Pacific Islander (AAPI) communities, and resources you can access for education, screening, and care.

What is hepatitis B?

The hepatitis B virus (HBV) causes the most common, serious liver infection in the world — approximately 2 billion people have been infected with this virus. 

People can become infected with HBV through bodily fluids such as blood or semen. Some examples of when this may occur include:

• During birth (from an HBV-infected pregnant person to their baby)

• Having sex with someone infected with HBV

• Sharing needles, syringes, or equipment used for drug preparation

• Contact with blood from someone infected with HBV (such as an open sore, razors, and medical equipment) 

If left untreated, chronic HBV infection can lead to serious complications, including liver cirrhosis and hepatocellular carcinoma, the most common form of liver cancer.

What’s more, 2 out of every 3 people with chronic HBV infections in the U.S. don’t know that they’re infected. This means that they can unknowingly spread it to others. This is why HBV screening is important, especially in people at high risk of infection.

How is hepatitis B treated?

Although there is no cure for hepatitis B, early detection can prevent complications. For some people, the infection is controlled by the immune system and goes away on its own — this is known as an acute hepatitis B infection. However, others may develop chronic hepatitis B, especially if they are infected at a younger age. 

Chronic hepatitis B treatment includes medications that are usually taken for at least one year. FDA-approved therapies include injections, like pegylated interferon (Pegasys) and interferon alpha (Intron A), and once-daily oral medications, like entecavir (Baraclude) and tenofovir alafenamide (Vemlidy).

If you’ve been exposed to HBV, make sure to contact your healthcare provider immediately. Treatments such as the hepatitis B vaccine and hepatitis B immune globulin (HBIG) may help prevent you from becoming infected.

Is hepatitis B preventable? 

Hepatitis B is not fully preventable, but there are vaccines available to help protect against it. 

The hepatitis B vaccine is the first vaccine that most people receive when they are born. The Centers for Disease Control and Prevention (CDC) recommends administering the hepatitis B vaccine to most babies within the first 24 hours of birth as long as they weigh more than 4.4 pounds. Depending on the person, the hepatitis B vaccine series consists of 3 or 4 shots. 

It’s a safe and effective vaccine recommended for all children up to 18 years old and for adults who are at high risk for HBV infections, including the following conditions or lifestyles:

• Kidney failure, including people requiring dialysis

• HIV infection

• Chronic liver disease

• Diabetes

• Working in healthcare

• Men who have sex with men

It’s important to know that hepatitis B can be prevented through vaccination. If you’re unsure whether you have received the hepatitis B vaccine, make sure to discuss this with your healthcare provider. In some cases, they may even recommend blood work, such as vaccine titers, to see if you’re fully protected from HBV.

Are certain communities more impacted by hepatitis B than others?

Hepatitis B is more common in certain countries around the world — especially in Africa and Asia. Similarly, some communities are more impacted by hepatitis B in the U.S. It’s believed that 70% of people with chronic hepatitis B living in the U.S. were born in other countries.

According to the U.S. Department of Health and Human Services (HHS), African Americans are 2.6 times more likely to die from hepatitis B than non-Hispanic whites. 

Although Asian Americans make up almost 6% of the U.S. population, the majority of hepatitis B cases diagnosed in the U.S. occur in Asian Americans and Pacific Islanders (AAPI).

That’s why the U.S. Preventive Services Task Force (USPSTF) and the CDC recommend HBV screening in many situations, including in people born in high-risk regions, as well as those born in the U.S. who weren’t vaccinated as infants and have parents from high-risk regions.

Hepatitis B rates among AAPI communities

Approximately 58% of people living with chronic hepatitis B in the U.S. are Asian Americans. Compared to less than 0.3% of the U.S. population, about 10% of the AAPI community in the U.S. are chronically infected with HBV. This highlights a startling difference within these high-risk communities.

Hepatitis B-related mortality rates in AAPI communities

Chronic hepatitis B can lead to serious complications, including cirrhosis and cancer. HHS estimates that Asian Americans are almost 8 times more likely to die from hepatitis B than non-Hispanic whites. 

In 2018, it’s reported that over 46% of deaths related to hepatitis B occurred in the AAPI community — which is the highest death rate among any ethnic or racial group in the U.S.

Why are AAPI communities at higher risk for hepatitis B?

Hepatitis B dates back to prehistoric years as early as the Bronze Age — between 8 to 20 thousand years ago. It’s believed that HBV strains today have similar genetic material as the early viruses that existed in Eurasia. 

Since the virus has existed in Asia for thousands of years, first-generation Americans from China, Korea, Vietnam, and the Pacific Islands may be at higher risk for hepatitis B. More so, the rates of infant immunization against HBV tend to be lower in these countries. 

Therefore, it’s common to see many people within the same family infected with hepatitis B since they may become infected with HBV during birth.

What are the biggest related risk factors contributing to hepatitis B disparity?

Although the majority of chronic hepatitis B infections in the U.S. occur in AAPI communities, some people may be at greater risk than others. These risk factors include the following:

Being born outside of the U.S.

One of the strongest risk factors for chronic hepatitis B is being born outside of the U.S. Almost 60% of people chronically infected with HBV immigrated to the U.S. from Asia — with people coming from China, the Philippines, and Vietnam accounting for about 37% of chronic HBV infections.

Limited English proficiency

One of the challenges with moving to a foreign country is learning a new language, which can create barriers to screening and care services if language services aren’t provided. 

Research shows that people in the AAPI community who preferred speaking a non-English language had a higher chance of being infected with HBV than those who spoke English.

Health insurance status

Research has also shown that people who lack health insurance or utilize government-funded insurance programs such as Medicaid or Medicare are more likely to have hepatitis B.

Lower income

Large income variations exist within the AAPI community and may prevent some people from accessing preventative health services. 

Family history of HBV

Having a family member with HBV is a risk factor for developing hepatitis B. Since the infection spreads during birth or through direct contact with blood or other bodily fluids, family members of people who have hepatitis B have a higher risk of getting infected. 

What barriers may keep AAPI communities from accessing adequate hepatitis B screening and care?

There are many societal, community, and individual barriers that may also affect access to hepatitis screening and care. These include, but are not limited to:

• Cultural barriers, including views on Western medicine

• Limited health literacy

• Lack of shared language between people and healthcare providers

• Fear of stigma or discrimination

• Inability to navigate health system

• Employer-based time off policies 

• Provider clinical policies (HBV screening not routinely done)

• Transportation and access to appropriate health care systems

• Lack of health insurance

• Lower income

What resources are available to help AAPI communities address hepatitis B and other health disparities?

Many resources are available to address hepatitis B health disparities among the AAPI communities. The first step is to improve knowledge and awareness of hepatitis B, including the importance of HBV testing and vaccination.

CDC: offers educational resources for AAPI communities, as well as other people who may be at higher risk for hepatitis B

Hepatitis B Foundation: a national organization dedicated to curing hepatitis B by offering educational materials, support groups, and training materials for healthcare providers

Hep B United: a national organization advocating for hepatitis B awareness, screening, and vaccination among high-risk communities

Asian Liver Center: a Stanford-based organization focused on addressing the high rates of hepatitis B and liver cancer among AAPI communities. They offer various educational and training materials for healthcare providers

JoinJade: a global campaign that originated from Stanford University offering different resources, including a tool to determine your risk for hepatitis B

Asian Health Coalition: an organization focused on addressing health disparities, such as hepatitis B among AAPI communities. Their Hepatitis Education and Prevention Program focuses on HBV screenings and hepatitis B vaccinations 

American Liver Foundation: a national organization promoting liver health and disease prevention and provides resources such as support groups and a helpline to learn more about the disease

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Written by:

Kevin Le, PharmD, BCPS, BCPPS

Kevin Le, PharmD, BCPS, BCPPS is a clinical pharmacy specialist in solid organ transplant at Ann & Robert H. Lurie Children’s Hospital of Chicago. He has been working as a pediatric pharmacist since 2016.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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