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Faculty Tram T. Tran, MD Associate Professor of Medicine

Increasing Cultural Competency of Clinicians to Close the Care Gap in Hepatitis B Companion Slides. Faculty Tram T. Tran, MD Associate Professor of Medicine UCLA David Geffen School of Medicine Medical Director of Liver Transplantation Cedars Sinai Medical Center Los Angeles, California .

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Faculty Tram T. Tran, MD Associate Professor of Medicine

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  1. Increasing Cultural Competency of Clinicians to Close the Care Gap in Hepatitis B Companion Slides Faculty Tram T. Tran, MD Associate Professor of Medicine UCLA David Geffen School of Medicine Medical Director of Liver Transplantation Cedars Sinai Medical Center Los Angeles, California 

  2. HBV Prevalence AmongAsians in California (2001-2006)[a] • Cross-sectional study • 3163 Asian-American adult volunteers screened • Prevalence of chronic HBV infection: 8.9% • 65.4% were unaware that they were infected • Asian Americans born in East Asia, Southeast Asia, or the Pacific Islands were 19.4 times more likely to be chronically infected than those born in the United States • Among the 12% who reported being vaccinated • 5.2% had chronic HBV infection • Among those not infected with HBV • 44.8% were seronegative for HBsAg and anti-HBs a Lin SY, et al. Hepatology. 2007;46:1034-1040.

  3. Socioeconomic Barriers to Diagnosis and Treatment • Language • Income and poverty • Educational attainment • Immigration and citizenship • Health workforce

  4. I. Language[a,b] • Ability to speak English tremendously affects healthcare access • Communication with providers • Accessing services (eg, Medicare/Medicaid) • Those with limited English • Less likely to have routine preventive care • Their children also less likely to receive care • Limits ability to understand and comply with medication use aFiscella K, et al. Medical Care. 2002;40:52-59. b Weinick RN, et al. Am J Public Health. 2000;90:1771-1774.

  5. II. Income and Poverty • Perception of increasing per capita income • Asians more likely to be living in poverty compared with whites (13% vs 8%); have lower per capita income • Disaggregated data: Asian subpopulations particularly affected by poverty US Census Bureau 2000

  6. III. Educational Attainment • 19% of Asians received less than a high school diploma (general US population, 20%; whites, 15%) • Asians more likely to have a bachelor’s degree (26% vs 16% in general US population) overall, except in some subgroups (eg, Southeast Asians) • Southeast Asians much lower rates of high school completion • Bimodal distribution is seen in some subgroups US Census Bureau 2000

  7. IV. Immigration and Citizenship • Employment • Although they have equal rates of full-time employment as citizens, noncitizen Asians are more likely to work for employers who don’t offer healthcare coverage • Naturalization rate • Half of foreign-born Asians become naturalized citizens • Variability among subgroups • Malaysian, Japanese, Indonesians, Hmong: < 1/3 become naturalized citizens • ~2/3 of Filipinos become naturalized citizens • US Census Bureau 2000

  8. V. Health Workforce • Physician Diversity • United States overall: 249 physicians/100,000 people • Asian subgroups: • Hmong, Laotian, Cambodian 24-40 physicians/100,000 people • Nursing Diversity • 11/16 Asian subgroups underrepresented in the nursing workforce US Census Bureau 2000

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