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Principal Investigator: GRACE X. MA
Organization: TEMPLE UNIV OF THE COMMONWEALTH
Fiscal Year: 2024
Award: $793,566
Funding agency: National Institute on Minority Health and Health Disparities
Abstract
Asian Americans (AAs) represent approximately 7% of the U.S. population but account for over half of all Hepatitis B virus (HBV) infections nationally. Among the estimated 2.4 million Americans living with HBV, 58% are AAs, who exhibit the highest HBV prevalence across U.S. population groups. Despite recommendations from the CDC and U.S. Preventive Services Task Force to screen individuals at elevated risk, an estimated 68–75% of AAs remain unscreened and undiagnosed. Underdiagnosis has been linked to limited engagement with healthcare services, unfamiliarity with the healthcare system, and difficulties navigating available health information. Most existing studies have not fully examined how multiple layers of influence affect HBV screening and liver disease treatment. Preliminary findings among Chinese, Korean, and Vietnamese populations suggest that screening and care gaps stem from a range of individual and clinical factors. These factors contribute to delays in diagnosis, reduced services to treatment, and worsening liver disease. This study aims to identify and analyze individual and clinical factors that influence HBV-related liver disease management and outcomes. Using an adapted Socio-Ecological Model, the project will build upon a 20-year Regional Cancer Network and established collaborations with healthcare providers and local organizations in the Philadelphia, New Jersey and New York City metropolitan areas. Employing a mixed-methods approach, the research team will: Aim1. Analyze the longitudinal relationship between individual-level factors and HBV screening and liver disease management among 2,000 Asian American participants; Aim2. Evaluate the influence of organizational-level factors within clinical settings on screening rates and care continuity; and Aim3. Examine how patient-level behaviors and clinical care practices influence HBV screening and treatment outcomes. An integrative analysis will determine how factors at individual and clinical levels jointly impact engagement with HBV care. This will be the first longitudinal study to examine HBV-related liver disease management in high-risk Asian American subgroups, including those with early-stage liver cancer. The study findings are expected to support the development of targeted strategies to improve the quality of HBV and liver disease care for all populations at risk, contributing to national efforts to reduce the burden of chronic liver diseases.
Terms: <21+ years old><Access to Care><Adult><Adult Human><Advanced Cancer><Advanced Malignant Neoplasm><Advocacy><Affect><African American group><African American individual><African American people><African American population><African Americans><American><Asia><Asian><Asian Americans><Black><Black race><COVID crisis><COVID epidemic><COVID pandemic><COVID-19><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><CV-19><Caring><Chinese><Chronic Hepatitis B><Cities><Clinical><Cognitive Discrimination><Communities><Community Health Centers><Community Surveys><Coronavirus Infectious Disease 2019><Crime><Data><Data Analyses><Data Analysis><Data Collection><Death Rate><Detection><Development><Diagnosis><Disadvantaged><Discrimination><Disparities><Disparity><Ethnic Group><Ethnic Origin><Ethnic People><Ethnic Population><Ethnic individual><Ethnicity><Ethnicity People><Ethnicity Population><Federally Qualified Health Center><Funding><Goals><HBV Prevalence><HBV infection><Health><Health Care Surveys><Health Disparities Research><Health Services Accessibility><Health disparities related research><Health system><Healthcare Surveys><Hepatic Cancer><Hepatic Disorder><Hepatitis><Hepatitis B><Hepatitis B Infection><Hepatitis B Prevalence><Hepatology><History><Immigrant><Immigration><Impoverished><Incidence><Individual><Inequality><Infection><Institution><Institutional Racism><Insurance><Intervention><Intervention Strategies><Interview><Koreans><Latine><Latinx><Linguistic><Linguistics><Link><Lived experience><Lived experiences><Liver diseases><Longitudinal Studies><Low income><Malignant neoplasm of liver><Methods><Modeling><NCMHD><NIH><NIMHD><National Center on Minority Health and Health Disparities><National Institute of Minority Health and Health Disparities><National Institute on Minority Health and Health Disparities><National Institutes of Health><Neighborhood Health Center><Neighborhoods><Non-Hispanic><Nonhispanic><Not Hispanic or Latino><Organizational Policy><Outcome><Patients><Philadelphia><Play><Population><Poverty><Procedures><Provider><Public Health><QOC><Quality of Care><Race><Races><Racial Group><Recommendation><Recording of previous events><Regional Cancer><Research><Research Resources><Resources><Role><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Services><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Shapes><Stereotyping><Structural Racism><Survey Instrument><Surveys><Systematic Racism><Systemic Racism><Trauma><U.S. Preventative Services Task Force><U.S. Preventative Task Force><U.S. Preventive Services Task Force><U.S. Preventive Task Force><US Preventative Services Task Force><US Preventative Task Force><US Preventive Health Services Task Force><US Preventive Services Task Force><US Preventive Task Force><USPSTF><United States National Institutes of Health><United States Preventative Services Task Force><United States Preventative Task Force><United States Preventive Services Task Force><United States Preventive Task Force><Vietnamese><Viral Hepatitis B><Work><access to health care><access to health services><access to healthcare><access to services><access to treatment><accessibility of health care><accessibility to health care><accessibility to health services><accessibility to healthcare><adulthood><anti-Asian><availability of services><barrier to care><barrier to health care><barrier to healthcare><barrier to treatment><cancer diagnosis><cancer disparity><cancer health disparity><cancer-related health disparity><care access><chronic HBV infection><chronic hepatitis B virus infection><collaboration with communities><community based organizations><community based participatory research><community collaboration><community led research><community organizations><community participatory research><community partnered participatory research><community-based collaboration><coronavirus disease 2019><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><coronavirus infectious disease-19><data interpretation><density><developmental><disease disparity><disparities in race><disparity due to race><disparity in cancer><disparity in health><ethnic subgroup><ethnicity group><experienced discrimination><hate crimes><health care access><health care availability><health care service access><health care service availability><health care settings><health disparities science><health disparity><health service access><health services availability><healthcare access><healthcare accessibility><healthcare availability><healthcare service access><healthcare service availability><healthcare settings><hepatic disease><hepatitis B virus prevalence><hepatopathy><high risk><histories><improved><inequality due to race><inequity due to race><infected with HBV><infected with hepatitis B><infected with hepatitis B virus><infection risk><infection with HBV><infection with hepatitis B virus><innovate><innovation><innovative><intervention design><interventional strategy><liver cancer><liver disorder><liver malignancy><long-term study><longitudinal outcome studies><longterm study><malignant liver tumor><mortality><mortality rate><mortality ratio><multidisciplinary><obstacle to care><obstacle to healthcare><participatory action research><patient navigator><perceived discrimination><perception of discrimination><poor health outcome><population based><primary care health center><primary health center><protective factors><race based disparity><race based inequality><race based inequity><race bias><race disparity><race related disparity><race related inequality><race related inequity><racial><racial background><racial bias><racial disparity><racial inequality><racial inequity><racial origin><racial population><racial subgroup><racially unequal><racism><reduced health outcome><residence><residential building><residential segregation><residential site><resilience><resilient><screening><screenings><segregation><self-reported discrimination><serum hepatitis><service availability><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><social><social cohesion><social norm><social role><structural determinants><structural factors><systematic review><theories><therapy design><treatment access><treatment design><uptake><worse health outcome>