Bio-Psycho-Social Drivers of Disparities in Liver Disease Progression among Korean Americans with Hepatitis B Infection

B型肝炎病毒（HBV）感染是全球最常见和最严重的肝脏病毒感染， 导致过早死于肝病或肝癌。慢性B型肝炎（CH B）感染和 在亚裔美国人中，由HBV引起的肝癌是最严重但最常见的肝癌之一， 美国肝癌发生过程中被忽视的健康差异问题 肝细胞癌（HCC）的发展越来越被认为是一个多因素， 多层次、多步骤的过程。人们对多重因素和潜在因素知之甚少 高风险亚裔美国人慢性肝病进展的机制演变 肝脏疾病模型对病毒、慢性炎症和氧化性DNA损伤具有重要作用。 可能影响这些疾病过程的辅助因素包括外源性和内源性因素。 然而，在慢性肝病的研究中，多水平框架的应用相对较新 疾病进展（例如，CHB表型，肝病严重程度）。此外，委员会认为， CHB患者的肝病进展存在很大差异， 尚未确定导致或负责生物系统损害的因素。的 本研究的目的是纵向研究慢性肝病患者中差异的多种途径， 使用接受CHB治疗的韩裔美国人的两个独特的基于诊所的患者队列进行疾病进展 来自韩裔美国肝病学家的护理。我们将招募和登记600名韩裔美国人CHB 患者病历审查、结构化患者访谈、生物标志物、定性和地理空间 将整合参考数据，以探索10年内肝脏疾病进展的多水平模型， 年临床窗口，在不良结局高风险组内。具体目标是：（1） 估计CHB表型和肝病严重程度的患病率，以及相关协变量， 初始访问;（2）确定多个因素（例如，社会环境，心理社会，行为， 临床和生物学属性）与肝病进展的变化相关;（3） 检查这些因素对CHB之间关系的调节和中介作用， 表型和不利的肝病结果（例如，（4）了解护理需求 在种族一致的肝病护理模式中， 解释性混合方法。最后，与来自大规模CHB队列的临床数据进行比较， 美国和韩国将加强普遍性。从这项拟议研究中获得的见解将提供 了解慢性肝病和肝脏疾病的多层次和多步骤过程的基础 CHB患者的高危人群中的癌症，并在多个 水平（政策，社会行为和临床），以减少肝病进展的差异。

Hepatitis B virus (HBV) infection is globally the most common and serious viral infection of the liver, causing premature deaths from liver diseases or liver cancer. Chronic hepatitis B (CHB) infection and liver cancer caused by HBV among Asian Americans is one of the most serious—but frequently neglected—health disparity issues in the U.S. Hepatocarcinogenesis from HBV infection to hepatocellular carcinoma (HCC) development has been increasingly recognized as a multifactorial, multi-level and multi-step process. Less is known about the multiple factors and the underlying mechanisms responsible for chronic liver disease progression in high risk Asian Americans. Evolving models of liver disease posit a strong role for virus, chronic inflammation and oxidative DNA damage. Co-factors that may influence these disease processes include exogenous and endogenous factors. The application of a multi-level framework, however, is relatively new in the study of chronic liver disease progression (e.g., CHB phenotype, liver disease severity) among CHB patients. Moreover, there is great variance in the hepatic disease progress among CHB patients, and the psychosocial factors contributing to or responsible for biological system impairment have not been identified. The goal of this study is to longitudinally examine the multiple pathways to disparities in chronic liver disease progression using two unique clinic-based patient cohorts of CHB Korean Americans receiving care from Korean-American hepatologists. We will recruit and enroll 600 Korean American CHB patients. Medical chart review, structured patient interviews, biomarkers, qualitative, and geo-spatially referenced data will be integrated to explore multi-level models of liver disease progression over a 10- year clinical window, within a group at high risk for adverse outcomes. The specific aims are: (1) to estimate the prevalence of CHB phenotypes and liver disease severity, and associated covariates at the initial visit; (2) identify how multiple factors (e.g., social environmental, psychosocial, behavioral, clinical and biological attributes) are associated with variation in liver disease progression; (3) to examine the moderating and mediating effects of these factors on the relationship between CHB phenotypes and adverse liver disease outcomes (e.g., HCC); and (4) to understand care-seeking behaviors and dynamics of care within an ethnically concordant liver disease care model using an explanatory mixed methods approach. Finally, comparison to clinical data from large CHB cohorts in US and Korea will strengthen generalizability. Insights gained from this proposed study will provide the groundwork to understand the multi-level and multi-step process of chronic liver disease and liver cancer among high risk population with CHB patients, and develop potential interventions at multiple levels (policy, social-behavioral and clinical) to reduce disparities in liver disease progression.