{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T23:48:12Z","timestamp":1782776892936,"version":"3.54.5"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"vor","delay-in-days":67,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100003625","name":"Ministry of Health and Welfare","doi-asserted-by":"publisher","award":["B007040300278, B0070226000344, B0070308000464, and B0070307000502"],"award-info":[{"award-number":["B007040300278, B0070226000344, B0070308000464, and B0070307000502"]}],"id":[{"id":"10.13039\/501100003625","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Ulleung County is a geographically isolated and medically underserved region in South Korea with a persistently high incidence of liver cancer. Using a community-based approach, this study aimed to estimate the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections and to identify associated risk factors. As part of the Ulleung Liver Cancer Prevention and Management Project, an interagency workgroup implemented community-based screening and health behavior surveys. Between 2019 and 2022, a total of 1,792 residents aged\u2009\u2265\u200940 years voluntarily participated, and data from 1,684 participants were analyzed. The prevalence of hepatitis B surface antigen (HBsAg) and hepatitis C virus antibody (anti-HCV) positivity was 7.19% and 1.37%, respectively. Lower educational attainment and lifetime smoking were significantly associated with HBsAg positivity, whereas cupping therapy performed at non-medical institutions was associated with anti-HCV positivity. HBsAg positivity was lower among individuals with tattoos. Although the high prevalence of HBV infection alone may not fully explain the elevated incidence of liver cancer in Ulleung County, it likely represents an important contributing factor. These findings highlight the value of community-based screening strategies for informing tailored hepatitis prevention efforts in geographically isolated populations.<\/jats:p>","DOI":"10.1038\/s41598-026-48166-2","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T12:37:03Z","timestamp":1777034223000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Persistent hepatitis burden in a geographically isolated and medically underserved population: a community-based study"],"prefix":"10.1038","volume":"16","author":[{"given":"Dong-Hee","family":"Ryu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun-Young","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soo-Jung","family":"Ha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nam-soo","family":"Hong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"48166_CR1","unstructured":"World Health Organization. International Agency for Research on Cancer \u2013 Cancer Today. (2020). https:\/\/gco.iarc.fr\/today\/ Accessed 20 Sep 2023."},{"key":"48166_CR2","unstructured":"World Health Organization. International Agency for Research on Cancer- IARC News. (2023). https:\/\/www.iarc.who.int\/news-events\/world-hepatitis-day-2023\/ Accessed 20 Sep 2023."},{"issue":"2","key":"48166_CR3","doi-asserted-by":"publisher","first-page":"229","DOI":"10.21037\/jgo.2017.03.14","volume":"8","author":"PJ Zamore","year":"2017","unstructured":"Zamore, P. J., deLemos, A. S. & Russo, M. W. Viral hepatitis and hepatocellular carcinoma: Etiology and management. J Gasterointest Oncol 8(2), 229\u2013242 (2017).","journal-title":"J Gasterointest Oncol"},{"issue":"1","key":"48166_CR4","doi-asserted-by":"publisher","first-page":"26","DOI":"10.47093\/2218-7332.2020.11.1.26-37","volume":"11","author":"EA Nabatchikova","year":"2020","unstructured":"Nabatchikova, E. A. et al. Liver fibrosis assessment by transient elastography in patients with liver cirrhosis after hepatitis C virus eradication. Sechenov Med. J. 11(1), 26\u201337 (2020).","journal-title":"Sechenov Med. J."},{"key":"48166_CR5","unstructured":"World Health Organization. Hepatitis C. (2024). https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/hepatitis-c Accessed 2 Jul 2024."},{"key":"48166_CR6","unstructured":"Korean Statistical Information Service (KOSIS). Population by sex & city, county, and district. (2023). https:\/\/kosis.kr\/statHtml\/statHtml.do?orgId=101&tblId=DT_1B04006&conn_path=I2 Accessed 26 Jul 2023."},{"key":"48166_CR7","unstructured":"Korean Statistical Information Service (KOSIS). Age-standardized cancer incidence by city, county, and district. (2023). https:\/\/kosis.kr\/statHtml\/statHtml.do?orgId=117&tblId=DT_117N_A11109&conn_path=I2 Accessed 20 Sep 2023."},{"key":"48166_CR8","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17217757","volume":"17","author":"DH Ryu","year":"2020","unstructured":"Ryu, D. H., Lee, Y. M., Park, J. M., Tak, W. Y. & Hong, N. S. Examining liver cancer patients and a high-risk group in vulnerable area: An experience from the Ulleung Liver Cancer Prevention and Management Project. Int. J. Environ. Health Res. 17, 7757 (2020).","journal-title":"Int. J. Environ. Health Res."},{"issue":"3","key":"48166_CR9","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1016\/j.phrp.2015.05.003","volume":"6","author":"YW Kang","year":"2015","unstructured":"Kang, Y. W. et al. Korea Community Health Survey data profiles. Osong Public Health Res. Perspect. 6(3), 211\u2013217 (2015).","journal-title":"Osong Public Health Res. Perspect."},{"issue":"10","key":"48166_CR10","doi-asserted-by":"publisher","first-page":"1724","DOI":"10.1002\/jmv.23661","volume":"85","author":"MH Seong","year":"2013","unstructured":"Seong, M. H. et al. Clinical and epidemiological features of hepatitis C virus infection in South Korea: A prospective, multicenter cohort study. J. Med. Virol. 85(10), 1724\u20131733 (2013).","journal-title":"J. Med. Virol."},{"key":"48166_CR11","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1038\/sj.bjc.6600436","volume":"87","author":"HR Shin","year":"2002","unstructured":"Shin, H. R. et al. Hepatitis B and C virus prevalence in a rural area of South Korea: The role of acupuncture. Br. J. Cancer 87, 314\u2013318 (2002).","journal-title":"Br. J. Cancer"},{"issue":"2","key":"48166_CR12","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1111\/liv.12617","volume":"35","author":"EM El-Chitany","year":"2015","unstructured":"El-Chitany, E. M., Wahab, M. M. A., El-Whab, E. W. A., Hassouna, S. & Farghaly, A. G. A comprehensive hepatitis C virus risk factors meta-analysis (1989\u20132013): Do they differ in Egypt?. Liver Int. 35(2), 489\u2013501 (2015).","journal-title":"Liver Int."},{"issue":"5","key":"48166_CR13","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1016\/j.ctim.2012.05.004","volume":"20","author":"A Nielsen","year":"2012","unstructured":"Nielsen, A., Kligler, B. & Koll, B. S. Safety protocols for Gua sha (press-stroking) and Baguan (cupping). Complement. Ther. Med. 20(5), 340\u2013344 (2012).","journal-title":"Complement. Ther. Med."},{"issue":"7","key":"48166_CR14","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1111\/ijd.12914","volume":"55","author":"SM Park","year":"2016","unstructured":"Park, S. M. et al. Adverse events associated with acupuncture: A clinicopathologic review. Int. J. Dermatol. 55(7), 757\u2013763 (2016).","journal-title":"Int. J. Dermatol."},{"issue":"1","key":"48166_CR15","first-page":"35","volume":"11","author":"GR Kim","year":"1981","unstructured":"Kim, G. R. Survey of hepatitis B surface antigen in the sera of health adults in the Seoul and Gyunggi-do areas. Korean J. Virol. 11(1), 35\u201340 (1981).","journal-title":"Korean J. Virol."},{"issue":"1","key":"48166_CR16","first-page":"57","volume":"9","author":"YO Ahn","year":"1987","unstructured":"Ahn, Y. O., Yoo, K. Y. & Park, B. J. An epidemiologic study on risk factors of hepatitis B infection in Korea. Epidemiol. Health 9(1), 57\u201365 (1987).","journal-title":"Epidemiol. Health"},{"issue":"1","key":"48166_CR17","first-page":"89","volume":"21","author":"KY Yoo","year":"1988","unstructured":"Yoo, K. Y., Park, B. J. & Ahn, Y. O. Seroepidemiology of hepatitis B virus infection in healthy Korean adults in Seoul. J. Prev. Med. Public Health 21(1), 89\u201397 (1988).","journal-title":"J. Prev. Med. Public Health"},{"issue":"5","key":"48166_CR18","doi-asserted-by":"publisher","first-page":"945","DOI":"10.3904\/kjim.2019.007","volume":"34","author":"SY Yim","year":"2019","unstructured":"Yim, S. Y. & Kim, J. H. The epidemiology of hepatitis B virus infection in Korea. Korean J. Intern. Med. 34(5), 945\u2013953 (2019).","journal-title":"Korean J. Intern. Med."},{"issue":"4","key":"48166_CR19","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1016\/S2468-1253(22)00386-7","volume":"8","author":"F Cui","year":"2023","unstructured":"Cui, F. et al. Global reporting of progress towards elimination of hepatitis B and C. Lancet Gastroenterol. Hepatol. 8 (4), 332\u2013342 (2023).","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"48166_CR20","unstructured":"Korea Disease Control and Prevention Agency. Korea National Health and Nutrition Examination Survey. (2021). https:\/\/knhanes.kdca.go.kr\/knhanes\/sub04\/sub04_04_01.do Accessed 20 Sep 2023."},{"issue":"4","key":"48166_CR21","doi-asserted-by":"publisher","first-page":"586","DOI":"10.1111\/liv.12108","volume":"33","author":"DY Kim","year":"2013","unstructured":"Kim, D. Y. et al. A nationwide seroepidemiology of hepatitis C virus infection in Korea. Liver Int. 33 (4), 586\u2013894 (2013).","journal-title":"Liver Int."},{"issue":"6","key":"48166_CR22","doi-asserted-by":"publisher","first-page":"958","DOI":"10.3346\/jkms.2005.20.6.985","volume":"20","author":"HR Shin","year":"2005","unstructured":"Shin, H. R., Hwang, S. Y. & Nam, C. M. The prevalence of hepatitis C virus infection in Korea: Pooled analysis. J. Korean Med. Sci. 20(6), 958\u2013988 (2005).","journal-title":"J. Korean Med. Sci."},{"key":"48166_CR23","first-page":"3","volume":"1","author":"SS Kweon","year":"2016","unstructured":"Kweon, S. S. & Cho, S. B. HCV epidemiology in Korea: focused on community based HCV epidemiological investigation at Jindo-gun. Single Topic Symp. 1, 3\u20139 (2016).","journal-title":"Single Topic Symp."},{"key":"48166_CR24","doi-asserted-by":"publisher","DOI":"10.4178\/epih.e2017017","volume":"39","author":"SH Jeong","year":"2017","unstructured":"Jeong, S. H. et al. Current status of hepatitis C virus infection and counter-measures in South Korea. Epidemiol. Health 39, e2017017 (2017).","journal-title":"Epidemiol. Health"},{"issue":"4","key":"48166_CR25","doi-asserted-by":"publisher","first-page":"389","DOI":"10.4269\/ajtmh.2002.66.389","volume":"66","author":"CS Wang","year":"2002","unstructured":"Wang, C. S., Chang, T. T., Yao, W. J. & Chou, P. Comparison of hepatitis B virus and hepatitis C virus prevalence and risk factors in a community-based study. Am. J. Trop. Med. Hyg. 66(4), 389\u2013393 (2002).","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"48166_CR26","unstructured":"Community Health Survey. (2021). https:\/\/chs.kdca.go.kr\/chs\/stats\/statsMain.do Accessed 26 Jul 2023."},{"key":"48166_CR27","doi-asserted-by":"publisher","first-page":"1430","DOI":"10.1038\/bjc.2011.360","volume":"105","author":"WP Koh","year":"2011","unstructured":"Koh, W. P. et al. Smoking as an independent risk factor for hepato-cellular carcinoma: The Singapore Chinese Health Study. Br. J. Cancer 105, 1430\u20131435 (2011).","journal-title":"Br. J. Cancer"},{"key":"48166_CR28","first-page":"241","volume":"14","author":"LY Wang","year":"2003","unstructured":"Wang, L. Y. et al. Risk of hepatocellular carcinoma and habits of alcohol drinking, betel quid chewing and cigarette smoking: A cohort of 2416 HBsAg-seropositive and 9421 HBsAg-seronegative male residents in Taiwan. Cancer Causes Control 14, 241\u2013250 (2003).","journal-title":"Cancer Causes Control"},{"issue":"5","key":"48166_CR29","doi-asserted-by":"publisher","first-page":"1261","DOI":"10.1158\/1055-9965.EPI-09-1297","volume":"19","author":"SC Chuang","year":"2010","unstructured":"Chuang, S. C., Lee, Y. A., Dai, M., Zheng, T. & Boffetta, P. Interaction between cigarette smoking and hepatitis B and C virus infection on the risk of liver cancer: A meta-analysis. Cancer Epidemiol. Biomarkers Prev. 19(5), 1261\u20131268 (2010).","journal-title":"Cancer Epidemiol. Biomarkers Prev."},{"issue":"5","key":"48166_CR30","doi-asserted-by":"publisher","first-page":"1312","DOI":"10.1111\/j.1572-0241.2000.02031.x","volume":"95","author":"AL Silverman","year":"2000","unstructured":"Silverman, A. L. et al. Tattoo application is not associated with an increased risk for chronic viral hepatitis. Am. J. Gastroenterol. 95(5), 1312\u20131315 (2000).","journal-title":"Am. J. Gastroenterol."},{"key":"48166_CR31","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1038\/nri1573","volume":"5","author":"B Rehemann","year":"2005","unstructured":"Rehemann, B. & Nascimbeni, M. Immunology of hepatitis B virus and hepatitis C virus infection. Nat. Rev. Immunol. 5, 215\u2013229 (2005).","journal-title":"Nat. Rev. Immunol."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-48166-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-48166-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-48166-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T23:37:50Z","timestamp":1782776270000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-48166-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,24]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["48166"],"URL":"https:\/\/doi.org\/10.1038\/s41598-026-48166-2","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,24]]},"assertion":[{"value":"7 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"19878"}}