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Lui Hac Minh Professor
Professor of Surgery
Director, Asian Liver Center
Department of Surgery
Stanford University School of Medicine
Palo Alto, California
Samuel So, MD, has no relevant conflicts of interest to report .
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Chronic viral hepatitis is a major public health problem in the United States and in California. An estimated 600,000 adults (2% of the adult population) in California are living with chronic hepatitis B or C infection. More people die in California from hepatitis B and C every year than in any other state.
Hepatitis B and C also represent major health inequities and disparities that disproportionately affect people of color living in California. An estimated 89% of adults in California with hepatitis B are Asian Americans or Pacific Islanders and 16% of adults with hepatitis C are Black Americans. In 2019, Asian Americans were 7.5 times and Black Americans were 2.3 times more likely to die from hepatitis B than non-Hispanic White Americans. The increase in risk of death from hepatitis C was approximately 2 times higher in Black Americans, 2.8 times higher in American Indians, and 1.25 times higher in Hispanic Americans compared with non-Hispanic White Americans. Hepatitis B and C account for more than one third of the liver transplants in adults in California each year.
Most Californians (93%) have health insurance coverage, and screening for hepatitis B and C according to the US Preventive Services Task Force (USPSTF) recommendations is covered by health insurance and hepatitis C treatment without fibrosis restrictions is covered by Medi-Cal (California Medicaid). Despite this, many Californians living with chronic hepatitis B or C remain undiagnosed and untreated. Although USPSTF recommend that hepatitis B and C screening should be offered to asymptomatic adults, many healthcare facilities that provide primary care services in California have yet to incorporate the screening recommendations in their routine practice, and many have yet to include screening and linkage to care and treatment into electronic health records.
This lack of screening may explain why the CDC estimates only one third of adults with chronic hepatitis B nationwide, 60% of those with hepatitis C are aware they are infected, and 26% with chronic hepatitis B and 43% with chronic hepatitis C are linked to hepatitis evaluation and treatment.
A New Hope
The California legislation AB 789 was passed with unanimous bipartisan support by both houses of the California legislature and signed into law by the governor. The new law, which came into effect on January 1, 2022, distinguished California as the first US state to require all healthcare facilities that provide primary care services to offer adult patients voluntary hepatitis B and C screening tests. For patients who test positive, the law requires healthcare professionals to provide care and treatment or refer their patients for care and treatment according to the American Association for the Study of Liver Diseases clinical practice guidelines on management of hepatitis B and C.
This Californian legislation was proposed by the Asian Liver Center at Stanford University and aims to close the gaps in hepatitis B and C diagnosis and treatment to prevent disease complications and death. With increased diagnosis and treatment, this new law could potentially save the lives of tens of thousands of Californians and, in the long term, could save California’s taxpayers hundreds of millions of dollars in future healthcare costs to treat liver cirrhosis and liver cancer caused by untreated chronic hepatitis B and C infection.
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