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American Journal of Epidemiology Advance Access originally published online on September 18, 2007
American Journal of Epidemiology 2007 166(9):1105-1106; doi:10.1093/aje/kwm261
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American Journal of Epidemiology © The Author 2007. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

LETTERS TO THE EDITOR

RE: "TEN LARGEST RACIAL AND ETHNIC HEALTH DISPARITIES IN THE UNITED STATES BASED ON HEALTHY PEOPLE 2010 OBJECTIVES"

Ellen T. Chang1,2 and Samuel K. S. So1

1 Asian Liver Center at Stanford University, Stanford, CA 94305
2 Northern California Cancer Center, Fremont, CA 94538

(e-mail: ellen{at}nccc.org)

In his article identifying the 10 largest racial and ethnic health disparities in the United States, Keppel (1) does not include chronic hepatitis B, despite the broad gap in prevalence between foreign-born Asians/Pacific Islanders and the rest of the US population (2). This omission may be attributable in part to the lack of population-based data on the prevalence of chronic hepatitis B in all racial and ethnic populations in the United States. Among foreign-born Asians/Pacific Islanders, who comprise the majority of all Asians/Pacific Islanders in the United States, the prevalence of chronic hepatitis B is consistently found to be approximately 10 percent (3–6). By contrast, the prevalence in the overall US population is below 0.5 percent (7) and that among White non-Hispanics is below 0.2 percent (8, 9). The wide disparity in the prevalence of chronic hepatitis B between Asians/Pacific Islanders and White non-Hispanics is striking, and the greater than 50-fold difference exceeds that for many of the other health disparities identified by Keppel. Population-based data on the prevalence of chronic hepatitis B in Black non-Hispanics, Hispanics, and American Indians/Alaska Natives are lacking. However, the prevalence of any hepatitis B (acute, chronic, or resolved) is higher in Black non-Hispanics than in Hispanics and is higher in both of these groups than in White non-Hispanics (7).

Not only does chronic hepatitis B constitute a wide racial and ethnic health disparity in the United States, it is also a particularly menacing one: If left unmonitored and untreated, one out of four persons with chronic hepatitis B will die from liver cancer or cirrhosis (10). Thus, chronic hepatitis B may be considered a more serious health threat than several of the other conditions included in the article. While we agree that the other health disparities listed by Keppel are worthy of attention, we believe that increasing public awareness and prevention of chronic hepatitis B and related liver disease should also be a prominent public health priority. Prevention of chronic hepatitis B can be achieved in a relatively straightforward manner through early-life vaccination against hepatitis B virus, perinatal prophylaxis in newborns born to chronically infected mothers, and education about routes of hepatitis B virus transmission (11, 12). In addition, among persons with chronic hepatitis B, prevention of death from liver cancer may be accomplished through routine screening (13) and, if appropriate, antiviral therapy (14). Therefore, it is reasonable to believe that through a concerted effort involving public health professionals, health-care providers, scientists, community leaders, and the general population, it is possible not only to reduce the racial and ethnic health disparity in chronic hepatitis B but to eliminate the disease altogether.


   ACKNOWLEDGMENTS
 
Conflict of interest: none declared.


   References
TOP
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Am. J. Epidemiol., November 1, 2007; 166(9): 1106 - 1107.
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