{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T17:55:56Z","timestamp":1781546156651,"version":"3.54.5"},"reference-count":26,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronic Hepatitis B (CHB) disproportionately affects immigrant and socioeconomically marginalized populations in the United States. Neighborhood-level metrics such as the Area Deprivation Index (ADI) may provide insight into structural and geographic indicators of CHB risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods and findings<\/jats:title>\n                    <jats:p>We used electronic health record data from the University of Washington Medicine system to assess the association between neighborhood-level social deprivation and a positive CHB status among adults aged \u226518 with at least one clinical encounter between 2018 and 2023. We conducted a case-control study where CHB cases were identified via positive hepatitis B surface antigen or detectable HBV DNA. Comparators were selected from patients who had a complete blood count (CBC) or chemistry panel testing as a general marker of healthcare engagement to ensure comparable opportunity for diagnosis. The comparators were then frequency matched to cases by care setting and calendar year quarter of medical encounter. Geocoded patient billing addresses were linked to census block groups to confer ADI scores, which were analyzed in 2-, 5-, and 10-level categories. Finer ADI stratification better captured gradients in neighborhood disadvantage and revealed the clearest trends; results from the 10-level ADI categories are noted here. Logistic regression models adjusted for age, sex, race, ethnicity, and insurance status were used to estimate odds ratios (OR) for CHB cases across ADI categories. The final study cohort included 5,729 CHB cases and 6,143 comparators. CHB was more common among individuals identifying as Asian, Black, or Native Hawaiian\/Pacific Islander, and those with public or no insurance. Adjusted models showed higher odds of a CHB positive test among residents of more disadvantaged neighborhoods, with the highest ADI category associated with twice the odds of CHB compared to the least disadvantaged category (adjusted OR = 2.07, 95% CI: 1.51\u20132.82), with an overall upward trend across ADI levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Neighborhood-level disadvantage was associated with higher odds of a CHB positive test when using granular stratification of ADI and after adjusting for individual-level factors. These findings support the integration of place-based metrics to inform targeted public health initiatives, including community-responsive education, and geographically focused hepatitis B screening and linkage-to-care efforts in socially disadvantaged neighborhoods.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0349563","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T17:28:24Z","timestamp":1781544504000},"page":"e0349563","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between neighborhood disadvantage and chronic hepatitis B in the central Puget Sound region of Washington, 2018 to 2023"],"prefix":"10.1371","volume":"21","author":[{"given":"Grace","family":"Dickel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristine","family":"Lan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Khosropour","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6710-9666","authenticated-orcid":true,"given":"H. Nina","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,6,15]]},"reference":[{"key":"pone.0349563.ref001","author":"CDC","year":"2024"},{"issue":"3","key":"pone.0349563.ref002","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.annepidem.2017.12.006","article-title":"Influence of birth origin and risk factor profile on hepatitis B mortality: Philadelphia, PA 2003-2013","volume":"28","author":"DC Higgins","year":"2018","journal-title":"Ann Epidemiol"},{"issue":"9","key":"pone.0349563.ref003","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.14309\/ajg.0000000000000651","article-title":"Prevalence of Chronic Hepatitis B Virus Infection in the United States","volume":"115","author":"JK Lim","year":"2020","journal-title":"Am J Gastroenterol"},{"issue":"1","key":"pone.0349563.ref004","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1186\/s40249-024-01225-0","article-title":"Disparities in hepatitis B virus healthcare service access among marginalised poor populations: a mixed-method systematic review","volume":"13","author":"C Li","year":"2024","journal-title":"Infect Dis Poverty"},{"issue":"2","key":"pone.0349563.ref005","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1002\/hep.30831","article-title":"Chronic hepatitis B prevalence among foreign-born and U.S.-born adults in the United States, 1999-2016","volume":"71","author":"MH Le","year":"2020","journal-title":"Hepatol Baltim Md"},{"issue":"26","key":"pone.0349563.ref006","doi-asserted-by":"crossref","first-page":"2456","DOI":"10.1056\/NEJMp1802313","article-title":"Making neighborhood-disadvantage metrics accessible \u2014 the neighborhood atlas","volume":"378","author":"AJH Kind","year":"2018","journal-title":"N Engl J Med"},{"issue":"6","key":"pone.0349563.ref007","doi-asserted-by":"crossref","DOI":"10.1097\/INF.0000000000003888","article-title":"Association of Area Deprivation Index With Severity of COVID-19 in Pediatric Patients: A Multisite Study of Racially and Ethnically Diverse Children","volume":"42","author":"S Acosta","year":"2023","journal-title":"Pediatr Infect Dis J"},{"issue":"5","key":"pone.0349563.ref008","doi-asserted-by":"crossref","first-page":"2620","DOI":"10.1245\/s10434-023-13099-x","article-title":"The Use of Area-Level Socioeconomic Indices in Evaluating Cancer Care Delivery: A Scoping Review","volume":"30","author":"C Markey","year":"2023","journal-title":"Ann Surg Oncol"},{"issue":"9","key":"pone.0349563.ref009","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1001\/jamadermatol.2024.2355","article-title":"Area Deprivation and Disease Severity in Adult Patients With Discoid Lupus Erythematosus","volume":"160","author":"DF Faden","year":"2024","journal-title":"JAMA Dermatol"},{"key":"pone.0349563.ref010","first-page":"1547","article-title":"The Effect of Neighborhood Disadvantage on Diabetes Prevalence","volume":"2017","author":"L Sheets","year":"2018","journal-title":"AMIA Annu Symp Proc"},{"issue":"4","key":"pone.0349563.ref011","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1016\/j.jceh.2023.01.005","article-title":"Impact of Race and Neighborhood Socioeconomic Characteristics on Liver Cancer Diagnosis in Patients with Viral Hepatitis and Cirrhosis","volume":"13","author":"X Ying","year":"2023","journal-title":"J Clin Exp Hepatol"},{"key":"pone.0349563.ref012","author":"E Walton","year":"2010"},{"issue":"6","key":"pone.0349563.ref013","doi-asserted-by":"crossref","first-page":"745","DOI":"10.2307\/2095833","article-title":"Limits of Ethnic Solidarity in the Enclave Economy","volume":"52","author":"JM Sanders","year":"1987","journal-title":"Am Sociol Rev"},{"issue":"3","key":"pone.0349563.ref014","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1111\/cico.12419","article-title":"Gentrification without segregation? race, immigration, and renewal in a diversifying city","volume":"19","author":"J Hwang","year":"2020","journal-title":"City Commun"},{"key":"pone.0349563.ref015"},{"key":"pone.0349563.ref016"},{"issue":"11","key":"pone.0349563.ref017","doi-asserted-by":"crossref","first-page":"765","DOI":"10.7326\/M13-2946","article-title":"Neighborhood socioeconomic disadvantage and 30 day rehospitalizations: an analysis of Medicare data","volume":"161","author":"AJ Kind","year":"2014","journal-title":"Ann Intern Med"},{"key":"pone.0349563.ref018","doi-asserted-by":"crossref","first-page":"1331049","DOI":"10.3389\/fonc.2024.1331049","article-title":"Most deprived Louisiana census tracts have higher hepatocellular carcinoma incidence and worse survival","volume":"14","author":"KL Ratnapradipa","year":"2024","journal-title":"Front Oncol"},{"issue":"12","key":"pone.0349563.ref019","doi-asserted-by":"crossref","first-page":"2471","DOI":"10.1002\/ijc.31280","article-title":"Fraction and incidence of liver cancer attributable to hepatitis B and C viruses worldwide","volume":"142","author":"D Maucort-Boulch","year":"2018","journal-title":"Int J Cancer"},{"issue":"6","key":"pone.0349563.ref020","article-title":"Epidemiology of viral hepatitis and hepatocellular carcinoma","volume":"142","author":"HB El-Serag","year":"2012","journal-title":"Gastroenterology"},{"issue":"2","key":"pone.0349563.ref021","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1002\/hep.31782","article-title":"An Updated Assessment of Chronic Hepatitis B Prevalence Among Foreign-Born Persons Living in the United States","volume":"74","author":"RJ Wong","year":"2021","journal-title":"Hepatol Baltim Md"},{"issue":"9","key":"pone.0349563.ref022","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1093\/pch\/6.9.655","article-title":"Hepatitis B in childhood: An update for the paediatrician","volume":"6","author":"LT Yeung","year":"2001","journal-title":"Paediatr Child Health"},{"issue":"6","key":"pone.0349563.ref023","doi-asserted-by":"crossref","DOI":"10.1016\/S1473-3099(23)00590-X","article-title":"Characterising the effectiveness of social determinants of health-focused hepatitis B interventions: a systematic review","volume":"24","author":"K Anyiwe","year":"2024","journal-title":"The Lancet Infectious Diseases"},{"key":"pone.0349563.ref024","doi-asserted-by":"crossref","first-page":"103205","DOI":"10.1016\/j.drugpo.2021.103205","article-title":"Socioeconomic stability is associated with lower injection frequency among people with distinct trajectories of injection drug use","volume":"94","author":"AA Artenie","year":"2021","journal-title":"Int J Drug Policy"},{"key":"pone.0349563.ref025","doi-asserted-by":"crossref","DOI":"10.1016\/j.amepre.2007.02.006","article-title":"Neighborhood socioeconomic status, personal network attributes, and use of heroin and cocaine","volume":"32","author":"CT Williams","year":"2007","journal-title":"Am J Prev Med"},{"key":"pone.0349563.ref026","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/j.drugalcdep.2017.10.025","article-title":"The association between neighborhood socioeconomic disadvantage and high-risk injection behavior among people who inject drugs","volume":"183","author":"J DeCuir","year":"2018","journal-title":"Drug Alcohol Depend"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0349563","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T17:28:29Z","timestamp":1781544509000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0349563"}},"subtitle":[],"editor":[{"given":"Usama","family":"Waqar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,6,15]]},"references-count":26,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,15]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0349563","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,15]]}}}