Prevalence and Diagnostic Determinants of Hepatitis B Infection Among Saudi Adults: Implications for Targeted Screening and Early Detection

<b>Background/Objectives:</b> Hepatitis B virus (HBV) remains a significant diagnostic and public health challenge worldwide. Despite widespread vaccination, underdiagnosis persists among adults in Saudi Arabia. This study estimated HBV prevalence and identified sociodemographic, clinical, and behavioral predictors relevant to improving targeted diagnostic screening. <b>Methods</b>: A cross-sectional study of 1196 Saudi adults aged ≥18 years was conducted between September 2024 and February 2025 using a structured questionnaire. Data on demographics, clinical history, and behavioral exposures were analyzed using chi-square tests and multivariate logistic regression to identify independent determinants of HBV infection. <b>Results</b>: The study included 1196 adults (60.0% female, mean age 31 ± 12 years). HBV prevalence was 2.0% (95% CI: 1.3-3.0%). Independent predictors included divorced/widowed marital status (OR = 3.99, <i>p</i> = 0.023), diabetes mellitus (OR = 3.59, <i>p</i> = 0.039), family history of HBV (OR = 2.55, <i>p</i> < 0.001), and massage exposure (OR = 3.99, <i>p</i> = 0.025). No significant associations were found with gender, education, or transfusion history. <b>Conclusions</b>: HBV infection persists among high-risk Saudi adults despite immunization success. Integrating HBV testing into diabetes care, premarital and household screening, and regulation of personal care services may enhance early diagnosis and advance national elimination goals.