Source Center for Liver Disease, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA.
Estimates of the prevalence of chronic hepatitis B (CHB) in the U.S. differ significantly and the contribution of foreign-born (FB) persons has not been adequately described. The aim of this study was to estimate the number of FB persons in the U.S. living with CHB by their country of origin. We performed a systematic review for reports of HBsAg seroprevalence rates in 102 countries (covering PubMed 1980 to July 2010). Data from 1,373 articles meeting inclusion criteria were extracted into country-specific databases. We identified 256 seroprevalence surveys in emigrants from 52 countries (including 689,078 persons) and 1,797 surveys in the general populations of 98 countries (including 17,861,035 persons). Surveys including individuals with lower or higher risk of CHB than the general population were excluded. Data were combined using meta-analytic methods to determine country-specific pooled CHB prevalence rates. Rates were multiplied by the number of FB living in the U.S. in 2009 by country of birth from the U.S. Census Bureau to yield the number of FB with CHB from each country. We estimate a total of 1.32 million (95% confidence interval, 1.04 million to 1.61 million) FB in the U.S. living with CHB in 2009; 58% migrated from Asia and 11% migrated from Africa, where hepatitis B is highly endemic. About 7% migrated from Central America, a region with lower CHB rates but many more emigrants to the United States. This analysis suggests that the number of FB persons living with CHB in the U.S. may be significantly greater than previously reported. Assuming 300,000-600,000 U.S.-born persons with CHB, the total prevalence of CHB in the U.S. may be as high as 2.2 million.