Hepatitis B and Hepatocellular Carcinoma Screening Practices in Chinese and African Immigrant-Rich Neighborhoods in New York City.
Hepatitis B and Hepatocellular Carcinoma Screening Practices in Chinese and African Immigrant-Rich Neighborhoods in New York City.
复制标题
DOI：
10.1007/s40615-016-0296-y
复制
发表时间：
2016-10-28
影响因子：
3.9
通讯作者：
Sarpel U
中科院分区：
文献类型：
--
作者：
Fitzgerald S;Chao J;Feferman Y;Perumalswami P;Sarpel U
背景来自中国和非洲的移民乙型肝炎病毒（HBV）和肝细胞癌（HCC）感染率较高；然而，初级保健医生 (PCP) 对高危社区筛查指南的遵守情况尚不清楚。 方法 根据美国人口普查数据确定了纽约市 (NYC) 拥有 25 个最大的中国和非洲移民人口的社区列表区域。美国医学会数据库用于识别在这些社区执业的 PCP。一项旨在评估 HBV 和 HCC 知识和筛查实践的网络调查已通过电子邮件分发给这些目标地区的 PCP。结果共联系了 2072 名医生，其中 109 名医生回复了调查，回复率为 5.3%。在做出回应的医生中，73% 的医生表示会定期对移民患者进行乙肝病毒检测。然而，如果患者 HBV 检测呈阳性，只有 68% 的医疗服务提供者建议筛查 HCC。超过四分之一 (27%) 的 PCP 未能正确指出抗病毒治疗可以降低患 HCC 的风险，只有 56% 的人正确回答肝癌筛查可提高生存率。在受访者中，只有 54% 的人正确回答了一名 25 岁的非洲 HBV 患者应该接受 HCC 筛查，而 53% 的人错误地回答了一名 25 岁的中国 HBV 患者应该接受 HCC 筛查，这表明两组人缺乏对肝癌不同发病年龄的认识。最常见的提供乙肝病毒检测和肝癌筛查的障碍是“缺乏明确的指南”。乙肝病毒和肝癌都不是患者医生认为的三大健康问题之一。中国和非洲移民社区的医疗服务提供者的反应没有显着差异。 结论 为纽约市的中国和非洲移民提供服务的医疗服务提供者常常无法建议适当的 HBV 和 HCC 筛查。这似乎是由于提供者的知识存在巨大差距以及缺乏对既定筛查指南的认识。这项研究表明，需要更好地向为移民富裕社区服务的医生分发现有指南，以改善高危人群的 HBV 和 HCC 筛查。
BackgroundImmigrants from China and Africa have high rates of hepatitis B virus infection (HBV) and hepatocellular carcinoma (HCC); however, primary care physician (PCP) adherence to screening guidelines in at-risk communities is not well understood.MethodsThe New York City (NYC) neighborhood tabulation areas with the 25 greatest Chinese and African immigrant populations were determined based on US census data. The American Medical Association database was used to identify PCPs practicing in these neighborhoods. A Web-based survey designed to assess HBV and HCC knowledge and screening practices was distributed via e-mail to PCPs in these target areas.ResultsA total of 2072 physicians were contacted, and 109 responded to the survey, for a response rate of 5.3 %. Among responding physicians, 73 % report routinely testing immigrant patients for HBV. However, if a patient tests positive for HBV, only 68 % of providers recommend screening for HCC. Over a quarter of PCPs (27 %), failed to correctly state that antiviral therapy can lower the risk of developing HCC, and only 56 % correctly replied that screening for liver cancer improves survival. Of responders, only 54 % answered correctly that a 25-year-old patient from Africa with HBV should be screened for HCC, whereas 53 % answered incorrectly that a 25-year-old patient from China with HBV should be screened, demonstrating a lack of awareness of the different age of onset of liver cancer in the two groups. The most commonly reported barrier to offering both HBV testing and HCC screening was a “lack of clear guidelines.” Neither HBV nor HCC was among the top 3 health concerns of patients, as perceived by their physicians. There were no significant differences between provider responses in Chinese and African immigrant neighborhoods.ConclusionsProviders serving Chinese and African immigrants in NYC often fail to recommend appropriate HBV and HCC screening. This appears to be due to significant gaps in provider knowledge and a lack of awareness of established screening guidelines. This study suggests the need for better distribution of existing guidelines to physicians serving immigrant-rich communities in order to improve HBV and HCC screening in high-risk individuals.