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The hepatitis B (HB) awareness level is an important factor affecting the rates of HB virus vaccination. To better understand income-related inequalities in the HB awareness level, it is imperative to identify the sources of inequalities and assess the contribution rates of these influential factors. This study analyzed the unequal distribution of the HB awareness level and the contributions of various influential factors. We performed a cross-sectional household survey with questionnaire-based, face-to-face interviews in 7 Chinese provinces. Responses from 7271 respondents were used in this analysis. Multinomial logistic regression was used for the analysis of contributing factors, and the concentration index was used as a measure of HB awareness inequalities. The HB awareness level varied across participants with different characteristics. Multinomial logistic regression of the explanatory factors of the HB awareness level showed that several estimated coefficients and relative risk ratios were statistically significant for middle- and high-level awareness, except for sex, occupation, and household income. The concentration index of the HB knowledge score was 0.140, indicating inequality gradients disadvantageous to the poor. The contribution rate of socioeconomic factors was the largest (60.8%), followed by demographic characteristics (29.0%) and geographic factors (4.3%). Demographic, socioeconomic, and geographic factors are associated with the HB awareness inequality. Therefore, to reduce inequality, HB-related health education targeting individuals with low socioeconomic status should be performed. Less-developed provinces, especially with high proportions of poor residents, warrant particular attention. Our findings may be beneficial to improve the HB virus vaccination rate for individuals with low socioeconomic status.

Introduction: With China's accelerating urbanization, migrant workers comprise up to 40% of the urban population of China's largest cities. More mobile than non-migrant urban dwellers, migrants are more likely to contract and spread hepatitis B (HB) than non-migrants. Due to the mandatory system of household registration (hukou), migrants are less likely to be covered by national HB immunization programs and also to have more limited access to public health services where they work than non-migrants. Migrants form a significant sub-group in all Chinese cities posing unique public policy vaccination challenges., Objective: Using protection motivation theory (PMT), we developed and measured HB cognitive variables and analyze the factors affecting HB vaccination behavior and willingness to vaccinate by migrant workers. We propose public policy interventions to increase HB vaccination rates of migrant workers., Methods: We developed a questionnaire to collect information on the HB vaccination characteristics of 1684 respondents from 6 provinces and Beijing. Exploratory factor analysis was used to create PMT variables and a binary logistic regression model was used to analyze the factors affecting migrant workers' HB vaccination behavior and willingness to vaccinate., Results: Vulnerability and response-efficacy were significant PMT cognition factors determining HB vaccination behavior. The HB vaccination rate for migrants decreased with increasing age and was smaller for the primary education than the high education group. The vaccination rate of the medical insurance group was significantly greater than the non-insured group, and the vaccination probability was significantly higher for the self-rated good health compared to the self-rated poor health group. Geographical birth location mattered: the vaccination rate for Beijing city and Ningxia province migrants were higher than for Hebei province and the vaccination rate was lower for migrants born far from health facilities compared to those located middle-near distances from health facilities. We also studied vaccination willingness for the unvaccinated group. For this group, vulnerability and self-efficacy cognition factors were significant factors determining HB vaccination willingness. The probability of willingness to vaccinate for the 46+ age group was significantly smaller than the 16-25 age group and the willingness to vaccinate was lower in Jiangsu and Hainan province than in Hebei province., Conclusion: Increased knowledge of HB cognition is an effective way for improving HB vaccination behavior and HB vaccination willingness of migrant workers. We also found that health intervention policies should focus on older migrants (age 46+), without medical insurance, with poorer self-reported health status and poor health services accessibility.

Hepatitis B virus (HBV) remains a challenging public-health issue in China. Hepatitis B carriers and patients suffer not only physically but also experience strong discrimination and stigma. China's rural population is 629 million. Thus, there is a great need to understand the situation surrounding HBV-related discrimination in everyday life in rural China. We studied 6,538 participants (≥18 y old) from 42 villages across 7 provinces (districts). Many studies have addressed discrimination against those with human immunodeficiency virus (HIV) and hepatitis C virus (HCV). However, few studies have addressed HBV-related discrimination. We found that the fear of HBV infection, not lack of knowledge about it, predominantly leads to HBV-related discrimination (although limited knowledge is also a cause). Notably, receiving the HBV vaccination contributes to reduced discrimination. In addition, the existence of fewer misunderstandings about false HBV transmission routes plays a more important role in discrimination than does understanding of true HBV transmission routes. Therefore, to reduce HBV-related discrimination, policy makers should consider eliminating HBV-related fear, strengthening adult HBV immunization programs, developing large-scale education dissemination about HBV transmission routes and non-transmission routes, and paying greater attention to target populations.