Disparities in hepatitis B diagnoses, associated risk factors, and time to diagnosis among migrants compared with Danish-born populations: A matched cohort study
1
City St George's University of London, London, United Kingdom
2
Queen Mary University of London, London, United Kingdom
3
University of Copenhagen, Copenhagen, Denmark
4
National Organization for People Living with Hepatitis B, Kampala, Uganda
5
University College London, London, United Kingdom
6
Statens Serum Institut, Copenhagen, Denmark
Popul. Med. 2026;8(Supplement Supplement 1):A648
ABSTRACT
BACKGROUND:
Chronic hepatitis B virus (HBV) infection remains a global public health challenge, with an estimated 1.3 million deaths worldwide, despite availability of an effective vaccine. In Europe, HBV burden is unevenly distributed, with substantially higher risk among migrant populations originating from regions with high HBV endemicity. Evidence on incidence, risk factors, and time-to-diagnosis in these populations remains limited. This study assessed HBV incidence, associated risk factors, and time-to-diagnosis among migrants in Denmark compared with Danish-born individuals.
METHODS:
We conducted a nationwide matched cohort study including migrants who obtained residency in Denmark over a 23-year period. Migrants were matched 1:6 by age and sex with Danish-born comparators. HBV diagnosis rates were calculated per 10,000 person-years. Adjusted incidence rate ratios (aIRRs) were estimated using multivariable quasi-Poisson regression models controlling for age, sex, substance use disorders, HIV infection, and hepatitis C virus (HCV) infection. Associations with region of origin and co-morbidities were examined, and time to HBV diagnosis was compared within and between cohorts.
RESULTS:
The study cohort comprised 179,110 migrants and 1,049,345 Danish-born individuals, among whom 1,362 HBV diagnoses were identified. Migrants had substantially higher HBV diagnosis rates than Danish-born individuals (5.6 vs 0.2/10,000). This elevated risk persisted after adjustment for confounders (aIRR 30.6, 95%CI 26.7–35.2). Among migrants, the mean time from arrival in Denmark to HBV diagnosis was 5.4 years (SD5.5). Migrant HBV cases were more frequently female, while Danish-born cases more commonly had substance use disorders, HCV or HIV co-infection, and acute HBV-related hospitalisations. Within the migrant cohort, higher HBV incidence was associated with HCV co-infection and origin from Southeast Asia, the Pacific, or Africa.
CONCLUSIONS:
Migrants experience markedly increased HBV risk and may face prolonged diagnostic delays. Early, culturally appropriate screening strategies targeting high-risk migrant populations are essential to reduce health inequities and support achievement of WHO 2030 HBV elimination goals.
Chronic hepatitis B virus (HBV) infection remains a global public health challenge, with an estimated 1.3 million deaths worldwide, despite availability of an effective vaccine. In Europe, HBV burden is unevenly distributed, with substantially higher risk among migrant populations originating from regions with high HBV endemicity. Evidence on incidence, risk factors, and time-to-diagnosis in these populations remains limited. This study assessed HBV incidence, associated risk factors, and time-to-diagnosis among migrants in Denmark compared with Danish-born individuals.
METHODS:
We conducted a nationwide matched cohort study including migrants who obtained residency in Denmark over a 23-year period. Migrants were matched 1:6 by age and sex with Danish-born comparators. HBV diagnosis rates were calculated per 10,000 person-years. Adjusted incidence rate ratios (aIRRs) were estimated using multivariable quasi-Poisson regression models controlling for age, sex, substance use disorders, HIV infection, and hepatitis C virus (HCV) infection. Associations with region of origin and co-morbidities were examined, and time to HBV diagnosis was compared within and between cohorts.
RESULTS:
The study cohort comprised 179,110 migrants and 1,049,345 Danish-born individuals, among whom 1,362 HBV diagnoses were identified. Migrants had substantially higher HBV diagnosis rates than Danish-born individuals (5.6 vs 0.2/10,000). This elevated risk persisted after adjustment for confounders (aIRR 30.6, 95%CI 26.7–35.2). Among migrants, the mean time from arrival in Denmark to HBV diagnosis was 5.4 years (SD5.5). Migrant HBV cases were more frequently female, while Danish-born cases more commonly had substance use disorders, HCV or HIV co-infection, and acute HBV-related hospitalisations. Within the migrant cohort, higher HBV incidence was associated with HCV co-infection and origin from Southeast Asia, the Pacific, or Africa.
CONCLUSIONS:
Migrants experience markedly increased HBV risk and may face prolonged diagnostic delays. Early, culturally appropriate screening strategies targeting high-risk migrant populations are essential to reduce health inequities and support achievement of WHO 2030 HBV elimination goals.
| eISSN: | 2654-1459 |
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