Hepatitis B vaccination among high-risk adults: Results from the National Health and Nutrition Examination Survey (NHANES), 2007-2010

Background: Hepatitis B virus (HBV) infection can be prevented and controlled through vaccination. However, only 24%-50% of high-risk adults in the United States (U.S.) have been vaccinated against HBV infection.

Methods: Data were analyzed from the National Health and Nutrition Examination Survey (NHANES) for two time periods, 2003-2006 (n=6459 adults) and 2007-2010 (n=6652 adults) to (1) assess the prevalence of hepatitis B vaccination uptake and the intrapersonal, interpersonal, and organizational level factors that may be associated with receiving hepatitis B vaccination among U.S. adults and (2) assess whether any changes occurred in the prevalence of and factors associated with hepatitis B vaccination uptake among high-risk adults from 2003-2006 to 2007-2010. A high-risk adult was defined as any adult reporting at least one of the following: a sexually transmitted infection in the past 12 months (e.g., herpes, chlamydia, gonorrhea, or genital warts), sex with another man if male, infection with HIV, or past or current injection drug use. All other adults were classified as non-high-risk.

Results: The study identified several individual, social, and, environmental factors that played a role in hepatitis B vaccination uptake among adults. In 2003-2006, five variables were independently associated with hepatitis B vaccination uptake including younger age, female sex, of non-Hispanic Black or Other race/ethnicity, having greater than a high school education, and having health insurance. In 2007-2010, six variables were independently associated with hepatitis B vaccination uptake which included younger age, female sex, of non-Hispanic Black race/ethnicity, having greater than a high school education, having health insurance, and being a high-risk adult. Among high risk adults (n=427), the prevalence of hepatitis B vaccination uptake increased from 37.6% in 2003-2006 to 47.0% in 2007-2010. Although not significant, this increase of almost 10 percentage points was notable and coincided with a change in the national vaccination policy.

Conclusions: Still less than one-half of high-risk adults in the U.S have been vaccinated against HBV infection. Urgent strategies that draw on the factors identified here that facilitate vaccination are needed to improve uptake among high-risk adults to reach the national goal of eliminating HBV infection in the U.S.

Keywords: hepatitis B vaccination, high-risk adults, intrapersonal, interpersonal, and organizational level factors.