Clinical factors associated with hepatitis B screening and vaccination in high-risk adults

Table 1 High-risk condition for which hepatitis B vaccine is recommended for amongst unvaccinated adults

High-risk conditions for HBV infection
People whose sex partners have hepatitis B
Sexually active persons who are not in a long-term monogamous relationship
Persons seeking evaluation or treatment for a sexually transmitted disease
Men who have sexual contact with other men
People who share needles, syringes, or other drug-injection equipment
People who have household contact with someone infected with the hepatitis B virus
Health care and public safety workers at risk for exposure to blood or body fluids
Residents and staff of facilities for developmentally disabled persons
Persons in correctional facilities
Victims of sexual assault or abuse
Travelers to regions with increased rates of hepatitis B
People with chronic liver disease, kidney disease, HIV infection, or diabetes
Anyone who wants to be protected from hepatitis B

HBV: Hepatitis B virus; HIV: Human immunodeficiency virus.

Table 2 Screening and vaccination cohort patient demographics

	Screening cohort				Vaccination cohort
Demographic	Entire screening cohort (n = 999)	Screened for HBV (n = 556)	Not screened for HBV (n = 443)	P-value	Entire vaccination cohort (n = 556)	Vaccinated against HBV (n = 242)	Not vaccinated against HBV (n = 314)	P-value
Male	60.6%	59.7%	61.6%	0.583	59.7%	59.5%	59.9%	0.999
Age				< 0.001				< 0.001
< 40	4.9%	7.9%	1.1%		7.9%	12.8%	4.1%
41-50	6.7%	11.5%	0.7%		11.5%	14.1%	9.6%
51-60	26.4%	22.3%	31.6%		22.3%	24.4%	20.7%
61-70	36.7%	28.2%	47.4%		28.2%	25.2%	30.6%
71-80	14.6%	15.6%	13.3%		15.6%	12.4%	18.2%
> 80	10.6%	14.4%	5.9%		14.4%	11.2%	16.9%
BMI				0.028				0.047
< 20	7.0%	8.7%	4.8%		8.7%	11.9%	6.3%
20-24.9	26.6%	29.0%	23.5%		29.0%	29.8%	28.3%
25-29.9	32.7%	31.5%	34.2%		31.5%	31.2%	31.8%
30-34.9	20.6%	19.0%	22.5%		19.0%	19.3%	18.9%
> 35	13.1%	11.7%	14.9%		11.7%	7.8%	14.7%
Race				0.006				0.001
White	53.5%	51.9%	48.1%		49.8%	36.1%	63.9%
Black	17.1%	61.4%	38.6%		18.9%	55.2%	44.8%
Hispanic	11.7%	67.5%	32.5%		14.2%	41.8%	58.2%
Other	17.7%	53.7%	46.3%		17.1%	53.7%	46.3%
Insurance				< 0.001				0.488
Private	59.4%	59.5%	40.5%		63.5%	41.4%	58.6%
Medicare	30.1%	53.5%	46.5%		29.0%	46.0%	54.0%
Medicaid	6.8%	45.6%	54.4%		5.6%	51.6%	48.4%
Uninsured	3.7%	29.7%	70.3%		2.0%	54.5%	45.5%

HBV: Hepatitis B virus; BMI: Body mass index.

Table 3 High-risk medical conditions or activities

	Screening cohort				Vaccination cohort
High risk condition	Entire screening cohort (n = 999)	Screened for HBV (n = 556)	Not screened for HBV (n = 443)	P-value	Entire vaccination cohort (n = 556)	Vaccinated against HBV (n = 242)	Not vaccinated against HBV (n = 314)	P-value
Intravenous drug use	1.9%	0.9%	3.2%	0.018	0.9%	1.2%	0.6%	0.769
Men who have sex with Men	5.0%	4.0%	6.3%	0.120	4.0%	5.8%	2.5%	0.085
Chronic kidney disease	48.1%	64.6%	27.5%	< 0.001	64.6%	73.1%	58.0%	< 0.001
End stage renal disease (dialysis)	41.3%	59.2%	19.0%	< 0.001	59.2%	69.0%	51.6%	< 0.001
Chronic liver disease	25.7%	26.4%	24.8%	0.614	26.4%	21.5%	30.3%	0.026
Alcohol hepatitis	3.2%	4.9%	1.1%	0.002	4.9%	2.9%	6.4%	0.091
Primary sclerosing cholangitis	0.5%	0.5%	0.5%	0.799	0.5%	0%	1.0%	0.347
Primary biliary cirrhosis	0.7%	0.2%	1.4%	0.067	0.2%	0%	0.3%	0.896
Cryptogenic liver	0.6%	0.7%	0.5%	0.895	0.7%	0.8%	0.6%	0.807
Hemochromatosis	0.2%	0%	0.5%	0.382	0%	0%	0%	n/a
Hepatitis C	10.3%	9.4%	11.5%	0.312	9.4%	8.9%	9.9%	0.799
Non-alcoholic fatty liver disease	10.1%	11.2%	8.8%	0.264	11.2%	7.9%	13.7%	0.042
Non-alcoholic steatohepatitis	1.6%	1.6%	1.6%	0.837	1.6%	0.8%	2.2%	0.337
Autoimmune hepatitis	0.7%	1.1	0.2%	0.221	1.1%	0.8%	1.3%	0.926
End stage liver disease (cirrhosis)	10.6%	12.8%	7.9%	0.017	12.8%	9.5%	15.3%	0.058
Human immunodeficiency virus	14.3%	7.9%	22.3%	< 0.001	7.9%	9.9%	6.4%	0.168
High risk sexual behavior	22.5%	20.5%	25.1%	0.102	20.5%	23.6%	18.2%	0.145
Diabetes mellitus	46.8%	43.0%	51.7%	0.007	43.0%	37.2%	47.5%	0.019

HBV: Hepatitis B virus.

Table 4 Other medical conditions

	Screening cohort				Vaccination cohort
Comorbidity	Entire screening cohort (n = 999)	Screened for HBV (n = 556)	Not screened for HBV (n = 443)	P-value	Entire vaccination cohort (n = 556)	Vaccinated against HBV (n = 242)	Not vaccinated against HBV (n = 314)	P-value
Acute liver failure	0.4%	0.4%	0.5%	0.782	0.4%	0.4%	0.3%	0.597
Dyslipidemia	43.2%	41.9%	44.9%	0.373	41.9%	38.8%	44.3%	0.231
Hypertension	59.6%	63.0%	55.3%	0.017	62.9%	68.2%	58.9%	0.031
Coronary artery disease	21.1%	24.3%	17.2%	0.008	24.3%	26.0%	22.9%	0.455
Chronic heart failure	10.2%	12.2%	7.7%	0.024	12.2%	11.6%	12.7%	0.775
Chronic obstructive pulmonary disease	5.6%	5.6%	5.6%	0.927	5.6%	4.1%	6.7%	0.265
Peripheral arterial disease	5.2%	6.1%	4.1%	0.191	6.1%	4.5%	7.3%	0.239
Cerebrovascular accident	7.2%	8.6%	5.4%	0.067	8.6%	11.2%	6.7%	0.088
Psychiatric disorder	10.0%	9.2%	11.1%	0.378	9.2%	8.7%	9.6%	0.836
Current tobacco user	6.6%	4.9%	8.8%	0.018	4.9%	3.7%	5.7%	0.370
Current Alcohol use	29.0%	31.3%	26.2%	0.090	31.3%	29.8%	32.5%	0.551
Cancer (any)	18.7%	19.1%	18.3%	0.816	19.1%	12.8%	23.9%	0.001

Table 5 Gastrointestinal history and healthcare utilization

	Screening cohort			Vaccination cohort
Variate	Screened for HBV (n = 556)	Not screened for HBV (n = 443)	P-value	Vaccinated against HBV (n = 242)	Not vaccinated against HBV (n = 314)	P-value
HCV serology	82.4%	19.2%	< 0.001	78.5%	85.4%	0.047
HCV infection	9.4%	11.5%	0.312	12.1%	10.2%	0.629
Hepatitis A vaccination	36.0%	0%	< 0.001	51.7%	23.9%	< 0.001
Hepatitis A (HAVab IgM or IgG)	26.1%	4.3%	0.002	27.9%	24.7%	0.616
1 or more primary care visit per year	43.8%	30.9%	< 0.001	38.1%	48.1%	0.030
1 or more emergency department visit per year	56.6%	26.7%	< 0.001	57.0%	56.4%	0.956
1 or more gastroenterology visit per year	35.4%	19.4%	< 0.001	31.9%	38.0%	0.166
MELD score (median; 25-75th percentile)	16 (11-23)	12 (8-20)	0.019	16 (11-22)	17 (12-24)	0.586
All-cause mortality	11.3%	2.7%	< 0.001	10.7%	11.8%	0.804
Liver-related mortality	2.0%	0.5%	0.067	2.4%	1.6%	0.662
Listed for liver-transplant	8.1%	5.6%	0.167	6.6%	9.2%	0.333

MELD: Model for end-stage liver disease.