Abstract
ObjectiveIn European countries, chronic hepatitis B (CHB) disproportionately affects migrants from medium- and high-endemic areas and is largely underdiagnosed. To inform policy and improve screening strategies, we measured the timing of CHB diagnosis after migration and its determinants among sub-Saharan migrants living in the Paris metropolitan area (France).DesignThe PARCOURS study is a retrospective life-event history survey conducted in health care services in 2012–2013 among 779 migrants from sub-Saharan Africa who were receiving care for CHB. We investigated the timing of CHB diagnosis from the time of arrival in France using the Kaplan-Meier method and characteristics associated with CHB diagnosis since the time of arrival in France using discrete-time multivariate logistic regression models.ResultsThe median CHB diagnosis occurred during the fourth year spent in France for men and during the second year spent in France for women. Among men, the probability of CHB diagnosis increased during years with (versus without) a temporary resident permit (aOR: 1.6, 95%CI: 1.1–2.2), a precarious accommodation (aOR: 1.7, 95%CI: 1.1–2.6), and hospitalization (aOR: 7.7, 95%CI: 3.4–15.1). Among women, CHB diagnosis was more likely to occur during years with unemployment (aOR: 1.9, 95%CI: 1.1–3.94), pregnancy (aOR: 6.6, 95%CI: 3.5–12.5) and hospitalization (aOR: 9.0, 95%CI: 2.95–32.3). For both sexes, the probability of CHB diagnosis was higher among those who migrated to France because they were threatened in their country.ConclusionThis study shows that social hardships (residential, economic, administrative) and contact with the health care system after arrival in France hasten access to a CHB diagnosis.
Highlights
Chronic hepatitis B (CHB) remains a public health issue because of to the severity of chronic liver-related diseases
The median CHB diagnosis occurred during the fourth year spent in France for men and during the second year spent in France for women
The probability of CHB diagnosis increased during years with a temporary resident permit, a precarious accommodation, and hospitalization
Summary
Chronic hepatitis B (CHB) remains a public health issue because of to the severity of chronic liver-related diseases (e.g., liver cirrhosis and liver cancer). In European countries, CHB disproportionately affects migrants from medium- or high-endemic areas and is an important issue for public health policy [3,4,5,6,7]. People born in medium- and high-endemic countries are frequently CHB-infected during the perinatal period or within the first years of their life, which exposes them to a higher risk of chronicity [8,9,10]. CHB screening among migrants from endemic countries is recommended in European countries [11], including France [12]. Testing, treatment and vaccination of migrants is not optimal because CHB screening is not systematically proposed by health professionals [6,13,14]. Barriers to CHB testing among migrants include a fear of stigma [15] and a lack of awareness of and misconceptions about CHB [16,17]
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