TitleCross sectional association of arsenic and seroprevalence of hepatitis B infection in the United States (NHANES 2003–2014)
Publication TypeJournal Article
Year of Publication2018
AuthorsCardenas, A, Smit, E, Welch, BM, Bethel, JW, Kile, ML
JournalEnvironmental Research
Pagination570 - 576
Date Published01/2018


  • Serology tests discern between hepatitis B infections and hepatitis B vaccinations.
  • Urinary arsenic concentrations are used as a biomarker of recent exposure.
  • Arsenic biomarkers were linked to serology indicative of hepatitis B infection.



Arsenic alters immunological parameters including antibody formation and antigen-driven T-cell proliferation.


We evaluated the cross-sectional relationship between urinary arsenic and the seroprevalence of hepatitis B (HBV) infection in the United States using data from six pooled cycles of the National Health and Nutrition Examination Survey (2003–2014, N = 12,447).


Using serological data, participants were classified as susceptible, immune due to vaccination, or immune due to past natural infection. We used multinomial logistic regression to evaluate the association between urinary DMA and HBV classification. A sensitivity analysis using total urinary arsenic (TUA) was also conducted. Both DMA and TUA were adjusted for arsenobetaine using a residual regression method


A 1-unit increase in the natural logarithm (ln) of DMA was associated with 40% greater adjusted odds of having immunity due to natural infection compared to being susceptible (Odds Ratio [aOR]: 1.40, 95% Confidence Intervals [CI] 1.15, 1.69), 65% greater odds of having immunity due to a natural infection (aOR: 1.65, 95% CI: 1.34, 2.04) and 18% greater odds of being susceptible (aOR: 1.18, 95% CI: 1.05, 1.33) compared to being immune due to vaccination after adjusting for creatinine, age, sex, race, income, country of birth, BMI, survey cycle, serum cotinine, recent seafood intake, and self-reported HBV immunization status.


In the U.S. general public, higher urinary arsenic levels were associated with a greater odds of having a serological classification consistent with a past natural hepatitis B infection after adjusting for other risk factors. Additionally, higher urinary arsenic levels were linked to a greater odds of not receiving hepatitis B vaccinations. Given the cross-sectional nature of this analysis, more research is needed to test the hypothesis that environmentally relevant exposure to arsenic modulates host susceptibility to hepatitis B virus.

Short TitleEnvironmental Research