A Cross-border Comparison of Hepatitis B Testing Among Chinese Residing in Canada and the United States


Background: The Western Pacific region has the highest level of endemic hepatitis B virus (HBV) infectionin the world, with the Chinese representing nearly one-third of infected persons globally. HBV carriers arepotentially infectious to others and have an increased risk of chronic active hepatitis, cirrhosis, and hepatocellularcarcinoma. Studies from the U.S. and Canada demonstrate that immigrants, particularly from Asia, aredisproportionately affected by liver cancer. Purpose: Given the different health care systems in Seattle andVancouver, two geographically proximate cities, we examined HBV testing levels and factors associated withtesting among Chinese residents of these cities.
Methods: We surveyed Chinese living in areas of Seattle andVancouver with relatively high proportions of Chinese residents. In-person interviews were conducted inCantonese, Mandarin, or English. Our bivariate analyses consisted of the chi-square test, with Fisher’s Exacttest as necessary. We then performed unconditional logistic regression, first examining only the city effect as thesole explanatory variable of the model, then assessing the adjusted city effect in a final main-effects model thatwas constructed through backward selection to select statistically significant variables at alpha = 0.05.
Results:Survey cooperation rates for Seattle and Vancouver were 58% and 59%, respectively. In Seattle, 48% reportedHBV testing, whereas in Vancouver, 55% reported testing. HBV testing in Seattle was lower than in Vancouver,with a crude odds ratio of 0.73 (95% CI = 0.56, 0.94). However after adjusting for demographic, health careaccess, knowledge, and social support variables, we found no significant differences in HBV testing between thetwo cities. In our logistic regression model, the odds of HBV testing were greatest when the doctor recommendedthe test, followed by when the employer asked for the test. Discussion: Findings from this study support the needfor additional research to examine the effectiveness of clinic-based and workplace interventions to promoteHBV testing among immigrants to North America.