Self-reported hepatitis B testing among noninstitutionalized adults in the United States before the implementation of universal screening, 2013–2017: A nationwide population-based study

Abstract

In 2023, the US Centers for Disease Control and Prevention recommended universal screening for hepatitis B virus (HBV); however, the proportion of US adults screened before implementing this recommendation is unknown. We analysed nationally representative data from the National Health Interview Survey (2013–2017) on self-reported HBV testing among noninstitutionalized US adults ≥18 years. We employed Poisson logistic regression to identify factors associated with self-reported testing, using a conceptual framework that included four overarching factors: sociodemographic characteristics, healthcare access, health-seeking behaviours and experiences, and access to internet-based health information. Among 149,628 survey respondents, the self-reported HBV testing rate was 27.2% (95% CI 26.2–28.7) and increased by 1.7% from 2013 to 2017 (p = .006). In adjusted analysis, health-seeking behaviours and experiences had the strongest associations of self-reported testing including a history of hepatitis (AOR 2.68, 95% CI 1.92–3.73), receipt of hepatitis B vaccination (AOR 5.11, 95% CI 4.61–5.68) and prior testing for hepatitis C (AOR 9.14, 95% CI 7.97–10.48) and HIV (AOR 2.69, 95% CI 2.44–2.97). Other factors associated with testing included being male (AOR 1.14, 95% CI 1.03–1.26), ages 30–44 years (AOR 1.37, 95% CI 1.17–1.61), 45–60 years (AOR 1.55, 95% CI 1.30–1.80) and ≥60 years (AOR 1.53, 95% CI 1.28–1.84), residence in the Western US region (AOR 1.23, 95% CI 1.06–1.43), and access to internet-based health information (AOR 1.32, 95% CI 1.18–1.47). Being Hispanic was associated with lower odds of testing (AOR 0.80, 95% CI 0.66–0.97). These findings may help guide optimal HBV screening in the universal testing era.