S Fitzgerald1, J Chao1, Y Feferman1, P Perumalswami1, U Sarpel2. 1. Icahn School of Medicine at Mount Sinai, New York, NY, USA. 2. Icahn School of Medicine at Mount Sinai, New York, NY, USA. umut.sarpel@mountsinai.org.
Abstract
BACKGROUND: Immigrants 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. METHODS: The 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. RESULTS: A 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. CONCLUSIONS: Providers 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.
BACKGROUND: Immigrants 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. METHODS: The 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. RESULTS: A 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. CONCLUSIONS: Providers 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.
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