Living the Life

Addressing Viral Hepatitis Among Minority Communities

By J. Nadine Gracia, MD, MSCE, Deputy Assistant Secretary for Minority Health (Acting), Office of Minority Health, U.S. Department of Health and Human Services

J. Nadine Gracia

Since 1991, routine vaccinations of infants has reduced hepatitis B virus (HBV) infection rates in children by more than 95 percent. And the incidence of acute hepatitis C (HCV) has declined 90 percent since 1992, in large part due to the screening of the blood supply. This progress illustrates the impact that public health policies and practices can have in only a few decades. And these successes should be celebrated.
During May’s national observance of Hepatitis Awareness Month, we are reminded that several racial and ethnic minority populations in the United States are disproportionately affected by viral hepatitis¹.

• African Americans are twice as likely to be infected with HCV compared to the general U.S. population. While African Americans represent only 12 percent of the U.S. population, they make up roughly 22 percent of the estimated 3.2 million chronic HCV cases. (Read my earlier blog post about working to eliminate viral hepatitis disparities in the African American community.)

• Hispanic adults aged 40 years and older are 30 percent more likely to be newly infected with HBV than their non-Hispanic white counterparts, due to lower vaccination rates.

• Asian Americans and Pacific Islanders (AAPIs) represent half of the estimated 1.4 million HBV-infected persons in the U.S., despite the fact that they only make up 5 percent of the overall population, as Assistant Secretary for Health Dr. Howard Koh observed in his blog post about this disparity earlier this month. While AAPIs have a disproportionately high prevalence of HBV, as well as liver cancer and liver failure associated with chronic infection, HBV is vaccine-preventable. However, many AAPIs encounter cultural barriers to receiving adequate and high quality health care² from an array of factors that may contribute to the high incidence of HBV-related mortality.

The HHS Office of Minority Health (OMH) is working to address these disparities as a partner in the cross-agency implementation of the Action Plan for the Prevention, Care and Treatment of Viral Hepatitis. In fact, OMH is a participating agency in more than a dozen of the specific actions detailed in the Action Plan. These efforts include working with Federal partners to reach specific at-risk populations with culturally sensitive and linguistically appropriate evidence-based interventions to strengthen community-based programs providing testing and linkages to care, particularly those serving foreign-born populations, as well as by publishing periodic reports on viral-hepatitis-associated health disparities and integrating hepatitis A and B vaccination as a standard of care in Federal prevention and clinical programs that serve priority populations.
Among the steps OMH is taking is our partnership with the Association of Asian Pacific Community Health Organizations (AAPCHO ) and the Hepatitis B Foundation to launch the Hep B United national campaign. The campaign aims to end hepatitis B by supporting community-based groups in their efforts to increase hepatitis B awareness, screening, vaccination, and access to care for all Americans, and AAPIs in particular. Just this week, the Hepatitis B Initiative of Washington, DC , a campaign partner, co-hosted an education session during the National Association of Professional Asian American Women conference to encourage screening and testing for viral hepatitis.

OMH encourages everyone to take the online viral hepatitis risk assessment recently launched by the CDC. In less than five minutes, this online tool will assess an individual’s risk for viral hepatitis in response to a series of questions — and will generate a summary of recommendations for testing and vaccination that people can print and take to their doctor to discuss. Our goal is that this risk assessment tool will raise awareness about this silent epidemic among members of the public, as well as the health care community. We are hoping that all of our partners will help us share information about this exciting new tool and encourage people to use it.
During Hepatitis Awareness Month and beyond, we invite all of you to join us, in and across your communities, as we continue our fight against viral hepatitis.
¹“Achieving health equity to eliminate racial, ethnic, and socioeconomic disparities in HBV-and HCV-associated liver disease.” The Journal of Family Practice. April 2010, Vol. 59, No. 04 Suppl: S37-S42. Accessed online at http://www.jfponline.com/pages.asp?AID=8516 May 29, 2012.
²Upadhyaya N,et. al. “Chronic hepatitis B: perceptions in Asian American communities and diagnosis and management practices among primary care physicians.” Postgrad Med. 2010 Sep; 122(5):165-75. Accessed via http://www.ncbi.nlm.nih.gov/pubmed/20861600 on May 29, 2012