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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
PubMed

Insights

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.

Keywords:
chronic hepatitis Bhepatitis D virushotspot analysisspatial epidemiology

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