Among the 2.4 million Americans living with chronic hepatitis B virus (HBV), Asian-Americans are disproportionately affected, having the highest rates of HBV infection and liver cancer. Even while this extraordinarily high risk for HBV infection is known, however, nearly three-quarters of the Asian-American population has never been screened for HBV – a statistic that may be driven in large part by structural racism and discrimination (SRD).

SRD shapes persistent health disparities by limiting access to care and by directly affecting health and health behaviors. Most research on SRD in the health sector, however, has focused on Black Americans and Latinx. Now, thanks to a new five-year, $4 million grant award from the National Institute on Minority Health and Health Disparities of the National Institutes of Health (NIH), researchers at the Center for Asian Health, Lewis Katz School of Medicine at Temple University and Fox Chase Cancer Center have an unprecedented opportunity to expand SRD research to include Asian-Americans.

The grant is the first of its kind to support research that addresses the impacts of structural racism and discrimination on liver cancer and liver disease in high-risk Asian-Americans. Specifically, the research will focus on three ethnic groups – Chinese-, Korean-, and Vietnamese-Americans – all located in the greater Philadelphia and New York City areas, where Temple researchers have cultivated partnerships with regional and community-based organizations and clinical partners.

“We are very excited to be able to work toward identifying SRD issues in health care for Asian-Americans and to explore how we can use that information to develop culturally aligned interventions to improve quality of care,” said Grace X. Ma, PhD, Associate Dean for Health Disparities, Founding Director of the Center for Asian Health, and Laura H. Carnell Professor in the Department of Urban Health and Population Science at the Katz School of Medicine and Principal Investigator on the NIH award.

With the new funding, Dr. Ma and colleagues will be taking the first step in a critical paradigm shift in research on Asian-American health issues – moving from individual-level to multi-level investigations.

“This study is part of Dr. Ma’s ongoing efforts to create foundations for processes and practices that will improve health status for high-risk Asian-Americans nationwide,” said Amy J. Goldberg, MD, FACS, Interim Dean of the Katz School of Medicine. “The findings the team learns in the process of implementing this study will be applicable to other health conditions affecting high-risk Asian-Americans across the U.S. Practicality and replicability are hallmarks of Dr. Ma’s work. ”

“Our research essentially will be a deep dive into structural and systemic issues related to liver disease disparities in Asian-Americans at three levels: the patient population, the health care system, and the community,” Dr. Ma explained.

Socio-historical hardship and trauma, structural barriers, lack of culturally and linguistically appropriate services and resources, segregation, mistrust of the health system, anti-Asian racism, immigration, and poverty are a few examples of SRD factors that fuel disparities in HBV and liver disease burden. Using integrative analyses, the researchers will examine these factors, as well as associations between individual, institutional, and community-level SRD and HBV screening uptake and linkage to care.

The new research will further align with global hepatitis elimination targets set forth by the World Health Organization.

“About 300 million people worldwide are living with chronic hepatitis B infection, even though infection with the virus is preventable through vaccination,” Dr. Ma said.

“Our hope is that this first multi-level and longitudinal study will not only help us understand how structural racism drives disparities in HBV infection and liver disease in Asian-American populations but also help improve quality of care for those affected by the virus, as well as advance hepatitis elimination initiatives.”

Research reported in this publication is supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health, award number R01MD017521.