Introduction: In 2018, the prevalence of past or present hepatitis B virus (HBV) infection in the United States was 4.3%. Evidence of HBV infection was highest among foreign-born adults. As of 2012, the prevalence of hepatitis B vaccine-induced immunity was 25% in the US. Meanwhile, the CDC recommends HBV vaccination for adults who are at-risk for contracting the infection, including sexually-active adults with more than one partner in the past 6 months and those exposed to blood among others.
Methods: The NHIS was queried for respondents in 2017—the only year in which a set of questions were included to assess patient access to effective communication in the past 12 months. Sample-weight adjusted multivariable logistic regressions defined adjusted odds ratios (AOR) and 95% confidence intervals (CI) of receiving the hepatitis B vaccine with response to one of the five questions on effective patient communication and cultural competency as the independent variable of interest, while controlling for relevant sociodemographic and clinical variables. Statistical analyses were conducted using Stata/IC 16.1 (StataCorp) with α=0.05.
Results: 19,371 participants aged 18 or above responded to the effective patient communication and cultural competency questions, with a median age of 54 (IQR 37-67). 66.79% were non-Hispanic white, 54.51% were female, 6.64% were uninsured, 3.17% were non-English speaking, and 16.04% were foreign-born. Respondents who were asked about their opinions and beliefs regarding their care (aOR 1.28, 95% CI 1.18-1.40, p< 0.001) and those who were given easy-to-understand information (aOR 1.18, 95% CI 1.00-1.40, p=0.04) were significantly more likely to receive HBV vaccination compared to their counterparts. Non-English-speaking participants (aOR=0.64, 95% CI, 0.46-0.89, p=.01), older, and uninsured individuals were less likely to have received any HBV vaccination (p< .001).
Discussion: Being inoculated against hepatitis B was positively correlated with measures of effective patient communication, and negatively correlated with being a non-English speaker, older, and uninsured. These inequities can be partially explained by implicit biases among healthcare providers, poor health literacy, and lack of healthcare access among others. Lack of effective patient communication contributes to those disparities, while effective patient communication improves outcomes in vaccination, healthcare, and satisfaction. Future studies and policies can build upon these comprehensive findings.
