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Geospatial Discrepancy of Chronic Hepatitis B and Hepatitis D Testing in Alberta: A Population-Based Spatial Analysis
Bryce Tkachuk1, Isabelle Couloigner2, Carla S Coffin1
1Division of Gastroenterology and Hepatology, Department of Medicine, Cumming, School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Journal of Viral Hepatitis
|August 14, 2026
Summary
Chronic hepatitis B (CHB) and hepatitis D virus (HDV) coinfection are significant health concerns. Anti-HDV testing in Alberta is infrequent and poorly aligned with CHB hotspots, suggesting a need for improved testing strategies.
Area of Science:
- Hepatology and infectious diseases
- Public health and epidemiology
- Geographic health analysis
Background:
- Chronic hepatitis B (CHB) and hepatitis D virus (HDV) coinfection are leading causes of cirrhosis and liver cancer.
- The geographic distribution of CHB and the alignment of anti-HDV testing with CHB burden are not well understood.
- Understanding these patterns is crucial for effective public health interventions.
Purpose of the Study:
- To investigate the geographic distribution of CHB prevalence in Alberta.
- To assess the alignment of anti-HDV testing and seropositivity with areas of high CHB burden.
- To identify potential gaps in current testing strategies for CHB and HDV coinfection.
Main Methods:
- Utilized a provincial laboratory database (2014-2022) to identify adults with CHB using a validated serologic algorithm.
- Geolocated CHB cases to Aggregate Dissemination Areas (ADAs) and linked them to health zones and rural-urban classifications.
- Calculated age- and sex-standardized CHB prevalence and employed spatial analysis techniques (descriptive mapping, spatial autocorrelation, hotspot analysis) to assess geographic clustering.
Main Results:
- Identified 8317 persons with CHB, with a provincial prevalence of 1.70 per 1000 population.
- CHB prevalence was highest in metropolitan areas (2.15 per 1000) and lower in remote regions (0.40 per 1000), with notable differences between Calgary and Edmonton.
- Only 17.5% of CHB patients were tested for anti-HDV, and 4.1% of those tested were positive. CHB prevalence hotspots were concentrated in metropolitan ADAs, but anti-HDV testing and positivity hotspots showed only partial overlap.
Conclusions:
- CHB burden in Alberta is geographically clustered, particularly in urban neighborhoods.
- Anti-HDV testing rates are low and do not fully align with areas of high CHB prevalence.
- Implementing reflex or systematic anti-HDV testing, coupled with geographically targeted outreach, could enhance case detection and management.
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