Hepatitis B Virus Screening Patterns amongst Physicians in Hawaii: Changes in a Decade


Purpose: Hawaii had the highest incidence of liver cancer in the US and had a unique patient population with many immigrants from the Pacific and Asia where Hepatitis B virus (HBV) was endemic. HBV screening in high risk populations was a recommended measure of preventative medicine, thus we sought to examine physician screening patterns for HBV in Hawaii. Methods: We retrospectively analyzed billing claims from 1999 to 2009 from the largest healthcare coverage provider in the state of Hawaii. We identified all patients (>18 years) who underwent HBV screening based on Current Procedural Terminology (CPT) billing codes. We collected data on age, gender and specialty of physicians ordering the screening tests. Analysis was done in 2013 and 2014. Results: Of an estimated 700,000 covered lives, 125,576 patients underwent HBV screening. We stratified the patients into two eras from 1999-2004 (N = 52,245) and 2005-2009 (N = 73,331) to examine temporal trends. In the first era, 30,975 women (59.3%) underwent HBV screening, compared to 49,950 women (69.1%) screened in the 2005-2009 era. There absolute number of tests increased, but the proportion done by primary care MDs decreased from 55.6% to 44.9%. OB/GYN screened 15.6% in the early era and 26.9% in later era. Conclusions: There was an increase in women aged 18 - 40 years screened in the 2005-2009 era compared to 1999-2004, most likely due to OB/GYN physicians’ screening of prenatal women. Physician education on HBV vaccination/treatment or appropriate referral should include OB/GYN as well as primary care physicians.

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Tran, C. , Kiyosaki, K. and Wong, L. (2015) Hepatitis B Virus Screening Patterns amongst Physicians in Hawaii: Changes in a Decade. Open Journal of Gastroenterology, 5, 139-145. doi: 10.4236/ojgas.2015.510023.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Lin, S.Y., Chang, E.T. and So, S.K. (2007) Why We Should Routinely Screen Asian American Adults for Hepatitis B: A Cross Sectional Study of Asians in California. Hepatology, 46, 1034-1040.
[2] Hagan, H., Campbell, J., Thiede, H., Strathdee, S., Oueller, I., Kapadia, F., et al. (2006) Self Reported Hepatitis C Virus Antibody Status and Risk Behavior in Young Injectors. Public Health Reports, 121, 710-719.
[3] Kim, W.R. (2009) Epidemiology of Hepatitis B in the United States. Hepatology, 49, 28-34.
[4] Hu, D.J., Xing, J., Tohme, R.A., Liao, Y., Pollack, H., Ward, J.W., et al. (2013) Hepatitis B Testing and Access to Care among Racial and Ethnic Minorities in Selected Communities across the United States. Hepatology, 58, 856-862.
[5] (2014) U.S. Preventive Services Task Force Recommendations on Hepatitis B Screening.
[6] U.S. Census Bureau, Fact sheet for Hawaii.
[7] Tsai, N., Holck, P.S., Wong, L.L. and Ricalde, A.A. (2008) Seroepidemiology of Hepatitis B Virus Infection: Analysis of Mass Screening in Hawaii. Hepatology International, 2, 478-485.
[8] Pobutsky, AM., Buenconsejolum, L., Chow, C., Palafox, N. and Maskarinec, G.G. (2005) Micronesian Migrants in Hawaii: Health Issues and Culturally Appropriate, Community Based Solutions. Californian Journal of Health Promotion, 3, 59-72.
[9] Kowdley, K., Wang, C.C., Roberts, H. and Brosqart, C.L. (2012) Prevalence of Chronic Hepatitis B among Foreign- Born Persons Living in the United States by Country of Orgin. Hepatology, 56, 422-433.
[10] National Cancer Institute. SEER data.
[11] Wong, L.L., Hernandez, B., Kwee, S., Albright, C., Okimoto, G. and Tsai, N. (2012) Healthcare Disparities in Asians and Pacific Islanders with Hepatocellular Cancer. American Journal of Surgery, 203, 726-732.
[12] Health Trends in Hawaii.
[13] Ferrante, J.M., Winston, D.G., Chen, P.H. and de la Torre, A.N. (2008) Family Physicians’ Knowledge and Screening of Chronic Hepatitis and Liver Cancer. Family Medicine, 40, 345-351.
[14] Foster, T., Hon, H., Kanwal, F., Han, S. and Spiegel, B. (2011) Screening High Risk Individuals for Hepatitis B: Physician Knowledge, Attitudes, and Beliefs. Digestive Diseases and Sciences, Published Online.
[15] CDC (2005) A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Part 1: Immunization of Infants, Children, and Adolescents. MMWR, 54, 1-23.
[16] CDC (1990) Protection against Viral Hepatitis: Recommendation of the Immunization Practices Advisory Committee (ACIP). MMWR, 39, 1-26.
[17] American Academy of Pediatrics, American College of Obstetricians and Gynecologists (1992) Guidelines for Perinatal Care. 3rd Edition, American Academy of Pediatrics, Elk Grove Village.
[18] Schrag, S.J., Fiore, A.E., Gonik, B., Malik, T., Reef, S., Singleton, J.A., et al. (2003) Vaccination and Perinatal Infection Prevention Practices among Obstetrician-Gynecologists. Obstetrics & Gynecology, 101, 704-710.
[19] Gonik, B., Jones, T., Contreras, D., Fasano, N. and Roberts, C. (2000) The Obstetrician-Gynecologist’s Role in Vaccine-Preventable Disease and Immunization. Obstetrics & Gynecology, 96, 81-84.
[20] Rosenthal, P., Wood, D.L., Greenspoon, J.S. and Pereyra, M. (1995) Hepatitis B Virus Serology in Pregnant Women: Transmittal of Results from Obstetricians to Pediatricians in California. The Pediatric Infectious Disease Journal, 14, 927-931. http://dx.doi.org/10.1097/00006454-199511000-00001
[21] Druss, B.G., Marcus, S.C., Olfson, M., Tanielian, T. and Pincus, H.A. (2003) Trends in Care by Nonphysician Clinicians in the United States. New England Journal of Medicine, 348, 130-137.
[22] Moses, R.E. and Feld, A.D. (2007) Physician Liability for Medical Errors of Nonphysician Clinicians: Nurse Practitioners and Physician Assistants. American Journal of Gastroenterology, 102, 6-9.
[23] Nestor, M.S. (2005) The Use of Mid-Level Providers in Dermatology: A Liability Risk? Seminars in Cutaneous Medicine & Surgery, 24, 148-151.

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