Associations between Neighborhood Disadvantage and Chronic Hepatitis B in the Central Puget Sound Region of Washington, 2018 to 2023

Abstract

Chronic Hepatitis B (CHB) disproportionately affects immigrant and socioeconomically marginalized populations in the United States. Neighborhood-level metrics such as the Area Deprivation Index (ADI) may provide insight into structural and geographic drivers of CHB risk. We conducted a cross-sectional study that used electronic health record data from the University of Washington Medicine healthcare system to assess the association between neighborhood-level social deprivation and history of a positive CHB diagnostic test among adults with clinical encounters between 2018 and 2023. CHB cases were identified via positive hepatitis B surface antigen or detectable HBV DNA, and the comparator group was frequency matched on care setting and time of encounter. Geocoded patient billing addresses were linked to census block groups to confer ADI scores, which were analyzed in 2-, 5-, and 10-level categories. Logistic regression models adjusted for age, sex, race, ethnicity, and insurance status were used to estimate odds ratios (OR) for CHB cases across ADI categories. The final study population included 5,729 CHB cases and 6,143 comparators. CHB was more common among individuals identifying as Asian, Black, or Native Hawaiian/Pacific Islander, and those with public or no insurance. Adjusted models showed higher odds of a CHB positive test among residents of more disadvantaged neighborhoods, with the highest ADI category associated with twice the odds of CHB compared to the least disadvantaged category (adjusted OR = 2.07, 95% CI: 1.51-2.82), with a dose-dependent trend across ADI levels. Neighborhood-level disadvantage was associated with higher odds of a CHB positive test when using granular stratification of ADI and after adjusting for individual-level factors. These findings support the integration of place-based metrics in public health strategies to reduce disparities in CHB burden to improve screening, prevention, and care.