Underestimation of chronic hepatitis B in APIs: A call for advocacy and action

Asians and Pacific Islanders (APIs) comprise half of all chronic hepatitis B virus (HBV) infections in the U.S., and chronic HBV infection and liver cancer remain the largest health disparities between APIs and other ethnicities. Chronic HBV infection leads to serious liver disease and early death in up to 25% of individuals, and its financial burden reaches $1 billion annually. It is a leading cause of hepatocellular carcinoma, which ranks 3rd among causes of cancer death in APIs. Because APIs are underrepresented in national surveillance data, we believe there is a significant underestimation in official estimates of national chronic HBV prevalence in the U.S. After performing recalculations using two different methods, we estimated the true prevalence of chronic HBV in the U.S. to be between 1.85 and 2 million people, substantially larger than the current estimate of 1.25 million (from NHANES data). Our recalculation approach uses prevalence and census data for major U.S. ethnicities, and accounts for new immigrants (including undocumented) and other high-risk groups not included in NHANES. The results of our analyses, while preliminary, strongly indicate that APIs chronically infected with HBV have been undercounted. Action must be taken to prioritize HBV as an important public health concern, to accurately assess the prevalence of chronic HBV in the U.S., and to develop programs to eliminate the burden and health disparity of chronic hepatitis B and liver cancer in APIs. The undercounting of APIs in national surveillance data may affect estimates of disease burden for other conditions as well.