Native Indian Population Research Articles

Mediating Whiteness: Triangular Racialization in the Anglo-Indian Picaresque

This article takes up the social production of race in nineteenth-century India through picaresque fiction. Through readings of Rudyard Kipling, Dion Boucicault, and W. M. Thackeray, it shows how picaresque form served as a specific mechanism of racial stabilization, a means of producing a consciously stopgap racial binary through the intervention of a third, triangulating racial term: Irishness. Understanding the triangular structure of whiteness’ “shapeshifting” brings into sharper relief the connections between three important scholarly foci regarding race in India: the ambiguous and fluid boundaries of Anglo-Indian whiteness, the belated assignment of “blackness” to native Indian populations, and the constant resignifications of Irish identity that demographic overrepresentation in India entailed. The case study of the picaresque reveals an imperialist culture more strategic and more self-aware about its own racial construction than is sometimes supposed; the genre served as a key means by which nonmetropolitan colonialist Victorians theorized and constructed their own relation to whiteness.

Distribution of celiac disease predisposing genes HLA-DQ2 and HLA-DQ8 in the native population of southern India.

Celiac disease (CD) is an intestinal inflammatory condition caused by the ingestion of gluten peptides in wheat and related grains in individuals carrying HLA-DQ2 and/or HLA-DQ8 genes. In comparison to HLA-DQ8, a higher HLA-DQ2 prevalence is reported in European population where wheat has been the staple food for thousands of years. In non-European population, this pattern of HLA-DQ CD-predisposing gene distribution has not always been found. The aim of this study was to evaluate the HLA-DQ2 and HLA-DQ8 distribution in the native low-gluten consuming southern Indian population. Overall, 211 dried blood spots (DBS) were collected from native southern Indian individuals. HLA-DQ characterization and the determination of homozygous/heterozygous status were performed using commercially availableHLA-DQ typing kits. Of 211 collected DBS, 88 (42%, 95% CI: 36-48) were positive for HLA-DQ2 and/or HLA-DQ8 heterodimers. Overall, 40 (19%, 95% CI: 14-24) samples typed positive for HLA-DQ2 and 48 (23%, 95% CI: 18-28) typed positive for HLA-DQ8 genotypes. Of 40 HLA-DQ2-positive individuals, only one subject tested homozygous for the DQB1*02 allele. In the southern Indian native general population, the prevalence of HLA-DQ8 is higher in comparison to HLA-DQ2 prevalence. This finding could be related to the delayed introduction of wheat in the diet of the southern Indian population.

Using the electronic health record to identify suicide risk factors in an Alaska Native Health System.

Suicide rates are higher in some Alaska Native and American Indian communities than the general U.S. population. Screening for suicide risk typically requires self-report, but many people may not engage with conventional screening because of distrust or are reluctant to disclose thoughts of suicide. Resource-sensitive methods of detecting suicide risk are needed. This study identifies routinely collected electronic health record data to identify demographic, clinical, and utilization factors associated with suicide-related visits in a tribal health care system. In this retrospective, case-control study, cases were defined as any person with a suicide-related visit from 2012 to 2015. Cases and controls were matched by age, sex, and urban/rural residence. We used conditional logistic regression to estimate odds ratios, which were interpreted as prevalence ratios (PR) based on the rare outcome assumption. The dataset included 314 cases and 1,169 controls. In the year before the index visit, cases had higher prevalence of poisoning or overdose (PR = 13.4, 95% confidence interval [CI] [3.5, 51.7]), emergency department and urgent care visits (PR = 15.8, 95% CI [6.6, 38.1]), and hospitalizations (PR = 4.5, 95% CI [3.0, 6.8]). Electronic health records can be used to identify factors that are significantly associated with suicide risk among those who may not be flagged by screening. Risk detection through electronic health record assessment might increase clinical workload in the short term, but this change would be offset by downstream prevention of suicide-related events. Such efforts could improve suicide risk detection and help to improve suicide-related health disparities in Alaska Native and American Indian populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Nicotine metabolism and its association with CYP2A6 genotype among Indigenous people in Alaska who smoke.

Prevalence of smoking is higher in Alaska Native and American Indian (ANAI) populations living in Alaska than the general US population. Genetic factors contribute to smoking and cessation rates. The objective of this study was to compare CYP2A6 genetic variation and CYP2A6 enzyme activity toward nicotine in an ANAI population. ANAI (N = 151) people trying to quit smoking were recruited. DNA samples were genotyped for CYP2A6 variants *1X2A, *1B, *2, *4, *9, *10, *12, and *35. Multiple nicotine metabolites were measured in plasma and urine samples, including cotinine and 3′‐hydroxycotinine used to determine CYP2A6 activity (e.g., nicotine metabolite ratio [NMR]). We calculated summary statistics for all of the genotypes and metabolites and assigned CYP2A6 activity scores based on known information. We studied the association of CYP2A6 variants with the NMR and smoking histories. The overall frequency of the CYP2A6*1B gain of function allele was high in the ANAI versus non‐ANAI populations in other studies. Both *4 null and *9 decrease of function alleles had frequencies similar to previous studies of ANAI populations. In a multivariate analysis, the genotype‐inferred CYP2A6 activity score was associated with both plasma and urine NMR (p value = 8.56E‐08 and 4.08E‐13, respectively). Plasma NMR was also associated with duration of smoking (p value < 0.01) but not urinary total nicotine equivalents uncorrected for creatinine (TNE9uc) or biological sex. Urine NMR was significantly associated (p value < 0.01) with TNE9uc. Variation in NMR in this ANAI population is explained in part by CYP2A6 genetic variation.

Home Blood Pressure Monitoring Devices: Device Performance in an Alaska Native and American Indian Population.

Objectives: Home blood pressure monitoring (HBPM) is an important component of blood pressure (BP) management. We assessed performance of two HBPM devices among Alaska Native and American Indian people (ANAIs). Methods: We measured BP using Omron BP786 arm cuff, Omron BP654 wrist cuff, and Baum aneroid sphygmomanometer in 100 ANAIs. Performance was assessed with intraclass correlation, paired t-tests, and calibration models. Results: Compared to sphygmomanometer, average BP was higher for wrist cuff (systolic = 4.8mmHg and diastolic = 3.6mmHg) and varied for arm cuff (systolic = -1.5mmHg and diastolic = 2.5mmHg). Calibration increased performance from grade B to A for arm cuff and from D to B for wrist cuff. Calibration increased false negatives and decreased false positives. Discussion: The arm HBPM device is more accurate than the wrist cuff among ANAIs with hypertension. Most patients are willing to use the arm cuff when accuracy is discussed.

Genetic diversity among two native Indian chicken populations using cytochrome c oxidase subunit I and cytochrome b DNA barcodes.

Background and Aim:India has large varieties (recognized, unrecognized) of native chickens (Desi) scattered throughout the country, managed under scavenging system different from commercial chicken breeds. However, they are less investigated for genetic diversity they harbor. The present study was planned to evaluate genetic diversity among two native chicken populations of North Gujarat (proposed Aravali breed) and South Gujarat (Ankleshwar breed). Aravali chicken, a distinct population with unique characters different from the registered chicken breeds of India is under process to be registered as a new chicken breed of Gujarat, India.Materials and Methods:Two mitochondrial markers, namely, cytochrome oxidase c subunit I (COX I) and cytochrome b (Cyt b) genes were studied across 10 birds from each population. Methodology included sample collection (blood), DNA isolation (manual), polymerase chain reaction amplification of mitochondrial genes, Sanger sequencing, and purification followed by data analysis using various softwares.Results:Haplotype analysis of the COX I gene unveiled a total eight and three haplotypes from the Aravali and Ankleshwar populations, respectively, with haplotype diversity (Hd) of 92.70 % for the Aravali and 34.50% for the Ankleshwar breed. Haplotype analysis of the Cyt b gene revealed a total of four haplotypes from the Aravali population with 60% Hd and no polymorphism in Ankleshwar breed. The phylogenetic analysis uncovered Red Jungle Fowl and Gray Jungle Fowl as prime roots for both populations and all domestic chicken breeds.Conclusion:Study findings indicated high genetic variability in Aravali chicken populations with COX I mitochondrial marker being more informative for evaluating genetic diversity in chickens.

Identification and futuristic role of novel polymorphism of caprine PrP gene

The Caprine Prion Protein (PrP) gene polymorphism in three different native Indian goat populations of Southern Odisha, namely Ganjam (a registered breed of India), Ghumusari and Raighar was studied. The 876 bp amplified segment of PrP gene contains full length coding sequence of 771 bp. In Ganjam and Ghumusari goats, any difference of nucleotide sequence was not identified. However, the comparison of nucleotide sequences of Raighar goats and goats of other locality revealed a change in nucleotide at five different positions (G190A, G724A, A727T, C775G and C800T) which includes two non-synonymous nucleotide changes. The non-synonymous nucleotide change resulted a change in amino acid at two different positions (Ser234Cys and Lys246Phe) in mature polypeptide which were not reported earlier and therefore, considered as novel. On the basis of these variants of PrP gene phylogenetic tree was constructed which showed that Ganjam and Raighar goats appeared in different clade. Since any occurrence of Scrapie infection in goats of Odisha was not reported, it can be proposed that these changes in amino acid may be responsible as resistance allele.

Социальная политика латиноамериканских стран в начале ХХI века: возможности и пределы

In the first decades of the 21st century, Latin American countries made significant steps towards social development. The period of the &ldquo;Golden Decade&rdquo; (2003&ndash;2013) was particularly successful, marked by high rates of economic growth, which most states of the region used to implement targeted social policies aimed at reducing poverty and social inequality, increasing employment, improving effectiveness of social protection of the population, education and health systems. An important part of the strategy for overcoming poverty were the conditional cash transfer programs, which aimed to reduce not only poverty, but also social exclusion, and to achieve a higher level of social development through small but permanent changes. The main actor of change would not be the state, but an individual or a family. Despite the ambiguity of the results obtained, which did not always correspond to efforts spent by the state, the experience of conditional cash transfer programs has become a part of an intensive search by Latin American countries for their own path of social development, due to specifics of accumulated problems and availability of real opportunities to solve them. The article analyzes the overall results of the policy on modernization of the social sphere, considers problems and challenges of the new stage. The latter began in 2014 and coincided with a slowdown in economic growth and general dissatisfaction with outcomes of social projects that did not lead to a drastic reduction of social inequality. The author highlights the key directions of forming a social strategy at the present stage, including a multi-factor approach to overcoming poverty, programs for young people, elderly people, and the native Indian population. There are new challenges relatable to the growth of mass social expectations, public disillusionment with the State&rsquo;s capabilities, and radical protest moods that increase the risks of political destabilization. The author comes to a conclusion that Latin American countries need to develop a new model of social policy aimed at radically overcoming social inequality, creating effective social elevators for young people from poor segments of society, and supporting a new middle class that has grown over the years of economic prosperity, but is vulnerable to the risks of a new economic crisis. Insufficient measures can reverse the process of social revival that has begun in the region.

Pharmacogenomics of Nicotine Metabolism: Novel CYP2A6 and CYP2B6 Genetic Variation Patterns in Alaska Native and American Indian Populations.

Alaska Native and American Indian (AN/AI) populations have higher tobacco use prevalence than other ethnic/racial groups. Pharmacogenetic testing to tailor tobacco cessation treatment may improve cessation rates. This study characterized polymorphic variations among AN/AI people in genes associated with metabolism of nicotine and drugs used for tobacco cessation. Recruitment of AN/AI individuals represented six subgroups, five geographic subgroups throughout Alaska and a subgroup comprised of AIs from the lower 48 states living in Alaska. We sequenced the CYP2A6 and CYP2B6 genes to identify known and novel gain, reduced, and loss-of-function alleles, including structural variation (eg, gene deletions, duplications, and hybridizations). Variant allele frequencies differed substantially between AN/AI subgroups. The gene deletion CYP2A6*4 and reduced function CYP2A6*9 alleles were found at high frequency in Northern/Western subgroups and in Lower 48/Interior subgroups, respectively. The reduced function CYP2B6*6 allele was observed in all subgroups and a novel, predicted reduced function CYP2B6 variant was found at relatively high frequency in the Southeastern subgroup. Diverse CYP2A6 and CYP2B6 variation among the subgroups highlight the need for comprehensive pharmacogenetic testing to guide tobacco cessation therapy for AN/AI populations. Nicotine metabolism is largely determined by CYP2A6 genotype, and variation in CYP2A6 activity has altered the treatment success in other populations. These findings suggest pharmacogenetic-guided smoking cessation drug treatment could provide benefit to this unique population seeking tobacco cessation therapy.

Abstract 227: The Acceptability and Impact of a Pilot Community Hands-Only Cardiopulmonary Resuscitation Training Program in India

Background: Sudden Cardiac Arrest (SCA) is a leading cause of global mortality. In India, 700,000 people die from SCA annually, many of which are under the age of 50. Immediate bystander CPR improves chances of survival, however, CPR education and training are difficult in a developing country such as India. In collaboration with University of Illinois Global Health Program, the Indian American Medical Association (Illinois), SHARE INDIA, and the American Heart Association we studied native rural Indian populations, hoping to enhance CPR education and skills training. This is the first rural community CPR project in India involving a university residency-training program from the USA. Methods: We conducted hands-only CPR training (based on the latest AHA guidelines) in the Telangana State in India, recruiting 582 participants with the help of local health outreach workers. A pre-training survey was used to assess baseline knowledge and impressions of CPR. This was followed by training in hands-only CPR consisting of an oral presentation followed by interactive CPR manikin training. A post-course survey was conducted after training. Chi square test and McNemar’s test were used for the analysis of data using SAS. Results: Of 582 participants, 65% were males and the mean age was 19.4 + 5.9. Gender was not associated with pre/post-test CPR knowledge, comfort with CPR, or belief in CPR efficacy. However, in paired analysis, there were significant differences (p&lt;0.0001) in all knowledge and perception measures from pre-to-post training. While only 6% knew the correct compression rate pre-training, 96% knew the correct answer post-training (4% vs. 94% in females, 6% vs. 96% in males). Similar results were seen for the compression depth variable. Training also improved comfort level in performing CPR (64% vs. 87% in females and 70% vs. 89% in males) and belief that CPR can save lives (49% vs. 96% in females and 51% vs. 97% in males). Conclusions: The program was successful in enhancing knowledge, comfort, and perceptions of CPR. Given the high prevalence of SCA in India, training the public in hands-only CPR can be a cost-effective care strategy in resource-limited areas. Due to the success of this pilot, we are planning to continue the program.

APPROACHES TO THE EVALUATION OF CULTURAL ADAPTATIONS OF HOME VISITING IN TRIBAL COMMUNITIES.

The research that underlies evidence-based practices is often based on relatively homogenous study samples, thus limiting our ability to understand how the study findings apply in new situations as well as our understanding of what might need to be adapted. In a preliminary effort to address those gaps, the requirements for the Tribal Maternal Infant and Early Childhood Home Visiting Program (MIECHV) included the expectation that grantees design and implement rigorous evaluations to address local priorities and to help build the knowledge base regarding the use of evidence-based home-visiting programs in tribal communities. A priority that emerged across many Tribal MIECHV grantees was to determine the added benefit of the cultural adaptations that they were making to their home-visiting programs. While there is literature to describe recommended processes for making cultural adaptations to evidence-based programs themselves, there are very few guidelines for evaluating these adaptations. In this article, we review the varied evaluation approaches utilized by Tribal MIECHV grantees and provide three case examples of how evaluators and tribal communities worked together to articulate evaluation questions and choose appropriate and feasible evaluation designs. The lessons derived from these Tribal MIECHV evaluation experiences have implications for the role of the evaluator in diverse communities across the country evaluating home visiting and other evidence-based practices in settings characterized by unique cultural contexts.

Los indígenas quiteños a través de sus testamentos: dinámicas socioculturales en el siglo XVII

This article analyzes Quito’s 17th century Native Indian population by means of studying their own personal testaments. Utilizing the microsocial scale, the author identifies the links that the Indian population established between themselves and different social groups (the Spaniards, mixed-race, mulatto and others). These relationships demonstrate the role that Indian women shouldered within the framework of urban dynamics, placing great emphasison their impact in the social and economic environs. Furthermore, the article strives to shed light on Quito’s Indigenous socioeconomic circumstances and daily routine by placing them in a heterogeneous, urban communal frame of reference. &nbsp

Ultrasonography-based Fetal Weight Estimation: Finding an Appropriate Model for an Indian Population

BackgroundVery limited information is available regarding the accuracy and applicability of various ultrasonography parameters [abdominal circumference (AC), biparietal diameter (BPD), femur length (FL), and head circumference (HC)]-based fetal weight estimation models for Indian population. The objective of this study was to systematically evaluate commonly used fetal weight estimation models to determine their appropriateness for an Indian population. MethodsRetrospective data of 300 pregnant women was collected from a tertiary care center in Bengaluru, India. The inclusion criteria were a live singleton pregnancy, gestational age > 34 weeks, and last ultrasound scan to delivery duration < 7 days. Cases with suspected fetal growth restriction or malformation were excluded. For each case, fetal weight was estimated using 34 different models. The models specifically designed for low birth weight, small for gestation age, or macrosomic babies were excluded. The models were ranked based on their mean percentage error (MPE) and its standard deviation (random error). A model with the least MPE and random error ranking was considered as the best model. ResultsIn total, 149 cases were found suitable for the study. Out of 34, only 12 models had MPE within ± 10% and only seven models had random error < 10%. Most of the Western population-based models had a tendency to overestimate the fetal weight. Based on MPE and random error ranking, the Woo's (AC-BPD) model was found to be the best, followed by Jordaan (AC), Combs (AC-HC-FL), Hadlock (AC-HC), and Hadlock-3 (AC-HC-FL) models. It was observed that the models based on just AC and AC-BPD combinations had statistically significant lesser MPE than the models based on all other combinations (p < 0.05). ConclusionIt was observed that the existing models have higher errors on Indian population than on their native populations. This points toward limitations in direct application of these models on Indian population without due consideration. Therefore, it is recommended that clinicians should exert caution in interpretation of fetal weight estimations based on these models. Moreover, this study highlights a need of models based on native Indian population.

Results of interferon-based treatments in Alaska Native and American Indian population with chronic hepatitis C

BackgroundThere have been few reports of hepatitis C virus (HCV) treatment results with interferon-based regimens in indigenous populations.ObjectiveTo determine interferon-based treatment outcome among Alaska Native and American Indian (AN/AI) population.DesignIn an outcomes study of 1,379 AN/AI persons with chronic HCV infection from 1995 through 2013, we examined treatment results of 189 persons treated with standard interferon, interferon plus ribavirin, pegylated interferon plus ribavirin and triple therapy with a protease inhibitor. For individuals treated with pegylated interferon and ribavirin, the effect of patient characteristics on response was also examined.ResultsSustained virologic response (SVR) with standard interferon was 16.7% (3/18) and with standard interferon and ribavirin was 29.7% (11/37). Of 119 persons treated with pegylated interferon and ribavirin, 61 achieved SVR (51.3%), including 10 of 46 with genotype 1 (21.7%), 38 of 51 with genotype 2 (74.5%) and 13 of 22 with genotype 3 (59.1%). By multivariate analysis, SVR in the pegylated interferon group was associated with female sex (p=0.002), estimated duration of infection (p=0.034) and HCV genotype (p<0.0001). There was a high discontinuation rate due to side effects in those treated with pegylated interferon and ribavirin for genotype 1 (52.2%). Seven of 15 genotype 1 patients treated with pegylated interferon, ribavirin and telaprevir or boceprevir achieved SVR (46.7%).ConclusionsWe had success with pegylated interferon-based treatment of AN/AI people with genotypes 2 and 3. However, there were low SVR and high discontinuation rates for those with genotype 1.

Prevalence of multiple sclerosis in Latin America and its relationship with European migration.

Multiple sclerosis (MS) is a chronic, degenerative autoimmune inflammatory disease of the central nervous system. The prevalence is different in every continent, changing according to geographical and environmental characteristics. The areas with the highest prevalence in the world are Europe and North America. In Latin America, the prevalence is higher in areas where there was greater European migration, as in the case of Argentina, Chile, Brazil, Uruguay and Mexico, and there have been no identified cases amongst native Indian populations. It should be considered that environmental factors may influence the prevalence of MS in Latin America, and it seems as if there are protective factors such as exposure to ultraviolet radiation and the presence of parasitosis.

Mortality Trends and Disparities in the Alaska Native and American Indian Population Living in Alaska, 1980–2011.

Mortality Trends and Disparities in the Alaska Native and American Indian Population Living in Alaska, 1980–2011.

Analysis of C-shaped canal systems in mandibular second molars using surgical operating microscope and cone beam computed tomography: A clinical approach.

Aims:The study was aimed to acquire better understanding of C-shaped canal systems in mandibular second molar teeth through a clinical approach using sophisticated techniques such as surgical operating microscope and cone beam computed tomography (CBCT).Materials and Methods:A total of 42 extracted mandibular second molar teeth with fused roots and longitudinal grooves were collected randomly from native Indian population. Pulp chamber floors of all specimens were examined under surgical operating microscope and classified into four types (Min's method). Subsequently, samples were subjected to CBCT scan after insertion of K-files size #10 or 15 into each canal orifice and evaluated using the cross-sectional and 3-dimensional images in consultation with dental radiologist so as to obtain more accurate results. Minimum distance between the external root surface on the groove and initial file placed in the canal was also measured at different levels and statistically analyzed.Results:Out of 42 teeth, maximum number of samples (15) belonged to Type-II category. A total of 100 files were inserted in 86 orifices of various types of specimens. Evaluation of the CBCT scan images of the teeth revealed that a total of 21 canals were missing completely or partially at different levels. The mean values for the minimum thickness were highest at coronal followed by middle and apical third levels in all the categories. Lowest values were obtained for teeth with Type-III category at all three levels.Conclusions:The present study revealed anatomical variations of C-shaped canal system in mandibular second molars. The prognosis of such complex canal anatomies can be improved by simultaneous employment of modern techniques such as surgical operating microscope and CBCT.

Genetic Variability of Inflammatory Genes in the Brazilian Population

Inflammatory gene variants have been associated with several diseases, including cancer, diabetes, vascular diseases, neurodegenerative diseases, arthritis, and others. Therefore, determining the population genetic composition of inflammation-related genes can be useful for the determination of general risk, prognostic and therapeutic strategies to prevent or cure specific diseases. We have aimed to identify polymorphism genotype frequencies in genes related to the inflammatory response in the Brazilian population, namely, IκBL -62AT, IκBL -262CT, tumor necrosis factors alpha (TNFa) -238GA, TNFa -308GA, lymphotoxin-alpha (LTa) +80AC, LTa +252AG, FAS -670AG, and FASL -844TC, considering the white, black, and Pardo ethnicities of the São Paulo State. Our results suggest that the Brazilian population is under a miscegenation process at the current time, since some genotypes are not in the Hardy-Weinberg equilibrium. In addition, we conclude that the Pardo ethnicity is derived from a complex mixture of ethnicities, including the native Indian population.

KIR diversity in three ethnic populations of Assam state, Northeast India

Killer immunoglobulin-like receptors (KIR) exhibit extensive diversity and it has been observed that populations with different ethno-history, linguistic, geographic and genetic backgrounds can differ in KIR profile. In this context, we have investigated the KIR complex in three ethnic populations-Kachari (n = 108), Ahom (n = 104) and Adivasi (n = 101) of Assam, Northeast India. The three populations had 145 distinct KIR genotypes in 313 individuals typed. The two Mongoloid populations--Kachari and Ahom had close genetic affinities with their parental East Asian groups where the Kachari clustered with Chinese populations and the Ahom in another clade clustered with Thailand Bangkok and Polynesian populations. The Adivasi differed markedly from these Mongoloid populations in having higher KIR 2DL2, 2DS2, 2DS3 and 2DS5, but lower 2DL3 (P value <0.0001). Like the other native Indian populations, the Adivasi had higher share of Bx-haplogroup and C4Tx genotype (37/101). However, unlike other Indian populations, KIR 3DS1 gene frequency was lower in Adivasi (21%) and was comparable to the African populations. The neighbor-joining dendogram generated on the basis of KIR gene frequencies of our study populations with 43 world populations also placed the Adivasi with African populations. Interestingly, the three populations in the dendogram are consistent with their migration histories. In summary, our data suggest that KIR profile of the three ethnic populations displayed ethnic diversity and was consistent with their migration history thereby supporting the concept that KIR diversity may be used to understand genetic affinity and migration history of populations.

Spatial and Temporal Dynamics of Hepatitis B Virus D Genotype in Europe and the Mediterranean Basin

Hepatitis B virus genotype D can be found in many parts of the world and is the most prevalent strain in south-eastern Europe, the Mediterranean Basin, the Middle East, and the Indian sub-continent. The epidemiological history of the D genotype and its subgenotypes is still obscure because of the scarcity of appropriate studies. We retrieved from public databases a total of 312 gene P sequences of HBV genotype D isolated in various countries throughout the world, and reconstructed the spatio-temporal evolutionary dynamics of the HBV-D epidemic using a Bayesian framework.The phylogeographical analysis showed that India had the highest posterior probability of being the location of the tree root, whereas central Asia was the most probable location of the common ancestor of subgenotypes D1–D3. HBV-D5 (identified in native Indian populations) diverged from the tree root earlier than D1–D3. The time of the most recent common ancestor (tMRCA) of the tree root was 128 years ago, which suggests that the common ancestor of the currently circulating subgenotypes existed in the second half of the XIX century. The mean tMRCA of subgenotypes D1–D3 was between the 1940s and the 1950–60s. On the basis of our phylogeographic reconstruction, it seems that HBV-D reached the Mediterranean area in the middle of the XX century by means of at least two routes: the first pathway (mainly due to the spread of subgenotype D1) crossing the Middle East and reaching north Africa and the eastern Mediterranean, and the second pathway (closely associated with D2) that crossed the former Soviet Union and reached eastern Europe and the Mediterranean through Albania. We hypothesise that the main route of dispersion of genotype D was the unsafe use of injections and drug addiction.