The Current Burden of Hepatitis B in the United States: A State, Territorial, and County Modelling Analysis

Accurate estimates of the prevalence of chronic hepatitis B virus (HBV) in the United States (US) are necessary for policy makers and community-based organisations to make informed decisions regarding the allocation of resources to work towards the elimination of HBV as a public health threat. The primary aim of this study was to quantify the current HBV prevalence in the US at the state, county, and territorial level. The secondary aim was to quantify which countries of birth lead HBV infections. Using previously validated and published population-based country level Markov models, the prevalence of HBV among immigrants in the US by country of birth was estimated in 2021. These estimates were then applied to county level population estimates from the 2018-2022 American Community Survey. This resulted in new county, state, territorial (Puerto Rico and Washington, D.C.), and national level HBV prevalence estimates. The total number of HBV infections in the US was estimated to be 1.7 million (UI: 795,000-4.1 million) corresponding to a prevalence of 0.50% (UI: 0.24%-1.23%). The state with the highest prevalence was Hawai'i, 1.3% (UI: 0.5%-40%), while Wyoming was estimated to have the lowest prevalence, 0.2% (UI: 0.1%-1.1%). The largest number of total infections was found in California, 347,100 (UI: 193,700-729,200). The Aleutians West Census Area was the county with the highest prevalence, 2.9% (UI: 0.8%-9.7%), while Los Angeles County had the highest number of infections, 96,700 (UI: 54,800-190,600). These data can aid planners at all levels to better understand the complexities of HBV in the US. Thus, providing evidence for targeted public health interventions that will reduce the burden of HBV and improve the lives of those living with the disease.