An Updated Assessment of Chronic Hepatitis B Prevalence Among Foreign-Born Persons Living in the United States
While prevalence of chronic hepatitis B (CHB) in the United States (U.S.) includes 0.42 million (range 0.28-0.67) U.S.-born individuals, foreign-born (FB) persons contribute a substantially larger number to the burden of CHB in the United States. Over the past decade, patterns of U.S. immigration have changed and many countries have implemented hepatitis B virus prevention programs. This study aims to estimate the number of FB persons with CHB in the U.S. by country of origin, updating our 2011 study. We performed systematic searches for articles published in 2009-2019 reporting hepatitis B surface antigen seroprevalence in emigrants and in-country populations of 117 countries. Data meeting inclusion criteria were combined with data from our 2011 study to calculate pooled prevalence estimates for 99 countries using meta-analyses (total 2,800 surveys involving 112 million subjects). Combining country-specific CHB rate estimates with the number of FB in the U.S. in 2018, by country of origin from the U.S. Census Bureau, we estimate the number of FB with CHB in the U.S. in 2018 was 1.47 million (95% confidence interval: 1.21-1.73), substantially higher than previously reported. The weighted average CHB prevalence for all FB in the U.S. in 2018 was 3.07%. About 59% of FB with CHB in the U.S. in 2018 emigrated from Asia, 19% from the Americas, and 15% from Africa. Subgroup analyses found that for many countries, CHB rates are higher in males than females and have declined over the past three decades, but no consistent pattern is seen between emigrant and in-country rates. Conclusion: Including FB and U.S.-born persons, the total prevalence of CHB in the U.S. may be as high as 2.4 million.