Hepatitis B Vaccination Uptake and Associated Factors in the United States Before Implementing Universal Vaccination: A Nationally-Representative Study.

Despite long-standing national vaccination recommendations targeting high-risk groups, hepatitis B vaccination (HepB) coverage among US adults remains low. To inform efforts following the 2022 recommendation for universal adult HepB vaccination, we analysed data from the National Health Interview Survey (2000-2018) to estimate national HepB vaccination coverage and identify factors associated with vaccine uptake. We used Poisson regression and a health behaviour framework to examine associations across four domains: Sociodemographic characteristics, healthcare access, health-seeking behaviours, and access to health information. Among 532,168 non-institutionalised US adults aged ≥ 18 years, the self-reported HepB vaccination rate was 27.9% (95% CI 27.6-29.7), increasing from 22% in 2000 to 35% in 2018. Health-related behaviours showed the strongest association with HepB vaccination, including prior hepatitis A vaccination (AOR 11.17, 95% CI 10.51-11.87), prior hepatitis B testing (AOR 4.70, 95% CI 4.47-4.93), and prior hepatitis C testing (AOR 1.28, 95% CI 1.21-1.35). Conversely, older age, lower educational level, and recent unemployment were associated with lower odds of HepB vaccination. Additionally, Black and Hispanic adults had lower odds of vaccination compared to white adults. These findings highlight persistent gaps in HepB vaccine coverage among particular segments of the US population and underscore the importance of vaccination efforts that focus on these communities to mitigate existing disparities and achieve the goal of universal HepB vaccination.