Obstetric service demand is the main health need of the Vietnamese population in Guangxi, China: A cross-sectional study.

China has become an emerging destination for international migration, especially in some Association of South East Asian Nations countries, but the situation of migrants seeking medical care in China remains unclear. A retrospective cross-sectional study was conducted in a hospital in Chongzuo, which provides medical services for foreigners, to investigate the situation of Vietnamese people seeking health care in Guangxi, China. Vietnamese patients who visited the hospital between 2018 and 2020 were included in the study. Demographic characteristics, clinical characteristics, characteristics of payment for medical costs, and characteristics of hospitalization were compared between outpatients and inpatients. In total, 778 Vietnamese outpatients and 173 inpatients were included in this study. The percentages of female outpatients and inpatients were 93.44% and 88.44% (χ2 = 5.133, P = .023), respectively. Approximately 30% of outpatients and 47% of inpatients visited the hospital due to obstetric needs. The proportions of outpatients with basic medical insurance for urban residents, basic medical insurance for urban employees, and new cooperative medical schemes were 28.02%, 3.21%, and 2.31%, respectively. In comparison, the proportion of inpatients with the above 3 types of medical insurance was 16.76%, 1.73%, and 2.31%, respectively. The proportion of different payments for medical costs between outpatients and inpatients were significantly different (χ2 = 24.404, P < .01). Middle-aged Vietnamese females in Guangxi, China, may have much greater healthcare needs. Their main medical demand is for obstetric services. Measurements should be taken to improve the health services targeting Vietnamese female, but the legitimacy of Vietnamese in Guangxi is a major prerequisite for them to access more and better healthcare services.

Suc Khoe là Hanh Phúc (Health is Happiness): promoting mammography and pap test adherence among Vietnamese nail salon workers.

Vietnamese nail salon workers have low cancer screening rates and confront multiple socioeconomic disparities as immigrants to the US. The Suc Khoe là Hanh Phúc (Vietnamese for "Health is Happiness") program was adapted to the cultural and work needs of this population and implemented at nail salons to increase cancer screening adherence. A total of 186 study participants were recruited from 59 nail salons in a neighborhood with mostly Asian population. After being pretested, workers were enrolled in a cancer education session delivered by Vietnamese lay health workers. Non-adherent cases were offered navigation to cancer screening services to a local federally qualified health center. Participants completed a posttest survey five months, on average. At posttest, navigated non-adherent participants were more likely to report a recent Pap test compared to cases not navigated (83.8% vs. 50.0%), an effect not observed for mammography uptake (77.3% vs. 71.4%). Time in the US, marital status, insurance status, having a primary care provider and/or a gynecologist were significantly associated with cancer screening adherence. Low rates of adherence to cancer screening among Vietnamese nail salons workers can be improved by community based programs addressing cultural and work-related barriers confronted by this population.

Impact of Effective Global Tuberculosis Control on Health and Economic Outcomes in the United States.

Rationale: Most U.S. residents who develop tuberculosis (TB) were born abroad, and U.S. TB incidence is increasingly driven by infection risks in other countries.Objectives: To estimate the potential impact of effective global TB control on health and economic outcomes in the United States.Methods: We estimated outcomes using linked mathematical models of TB epidemiology in the United States and migrants' birth countries. A base-case scenario extrapolated country-specific TB incidence trends. We compared this with scenarios in which countries achieve 90% TB incidence reductions between 2015 and 2035, as targeted by the World Health Organization's End TB Strategy ("effective global TB control"). We also considered pessimistic scenarios of flat TB incidence trends in individual countries.Measurements and Main Results: We estimated TB cases, deaths, and costs and the total economic burden of TB in the United States. Compared with the base-case scenario, effective global TB control would avert 40,000 (95% uncertainty interval, 29,000-55,000) TB cases in the United States in 2020-2035. TB incidence rates in 2035 would be 43% (95% uncertainty interval, 34-54%) lower than in the base-case scenario, and 49% (95% uncertainty interval, 44-55%) lower than in 2020. Summed over 2020-2035, this represents 0.8 billion dollars (95% uncertainty interval, 0.6-1.0 billion dollars) in averted healthcare costs and $2.5 billion dollars (95% uncertainty interval, 1.7-3.6 billion dollars) in productivity gains. The total U.S. economic burden of TB (including the value of averted TB deaths) would be 21% (95% uncertainty interval, 16-28%) lower (18 billion dollars [95% uncertainty level, 8-32 billion dollars]).Conclusions: In addition to producing major health benefits for high-burden countries, strengthened efforts to achieve effective global TB control could produce substantial health and economic benefits for the United States.

Health Conditions, Outcomes, and Service Access Among Filipino, Vietnamese, Chinese, Japanese, and Korean Adults in California, 2011-2017.

Objectives. To determine the impact of data disaggregation on the ability to identify health disparities and needs for future research for Filipino, Vietnamese, Chinese, Japanese, and Korean adults in California.Methods. Using available data from the 2011-2017 California Health Interview Survey, we conducted bivariate and multivariable analyses to assess disparities in health conditions, outcomes, and service access compared with non-Hispanic Whites for Asians as an overall group and for each individual subgroup.Results. As an aggregate category, Asians appeared healthier than did non-Hispanic Whites on most indicators. However, every Asian subgroup had at least 1 disparity disguised by aggregation. Filipinos had the most disparities, with higher prevalence of fair or poor health, being obese or overweight, and having high blood pressure, diabetes, or asthma compared with non-Hispanic Whites (P < .05) in multivariable analyses.Conclusions. Failure to disaggregate health data for individual Asian subgroups disguises disparities and leads to inaccurate conclusions about needs for interventions and research.

Using the Social Ecological Model to Identify Drivers of Nutrition Risk in Adult Day Settings Serving East Asian Older Adults.

Adult day care (ADC) centers provide community-based care (including meals) to frail, ethnically diverse older adults, many of whom are at risk for malnutrition. To support the development of interventions to benefit ADC users, the authors aimed to identify barriers and facilitators of healthy nutrition among ADC users born in Vietnam and China. Semi-structured qualitative interviews were conducted among ADC stakeholders to identify barriers and facilitators. Data were analyzed using Braun and Clarke's six-step method and organized within the framework of the Social Ecological Model. Facilitators of good nutrition included adherence to traditional diet at the ADC center, peer networks, and access to ethnic grocers. Poor health, family dynamics, and loneliness all contributed to poor nutrition, as did the restrictive nature of nutrition programs serving ADC users in the United States. Individual, relationship, organizational, community, and policy level factors play a role in ADC users' nutritional status. Targeted nutrition interventions should leverage culturally congruent relationships between ADC users and staff and include advocacy for enhancement of federal programs to support this population. [Research in Gerontological Nursing, 13(3), 146-157.].

Describing Vulnerability and Resiliency through Photovoice: Generational Perspectives from the Mississippi Gulf Coast Vietnamese Community.

The Mississippi Gulf Coast's Vietnamese community (MSGCVC) has repeatedly experienced physical, psychological, and economic hardship from natural and man-made disasters and economic downturn. Literature suggests that economic strain is the greatest contributor to Vietnamese population vulnerability. Previous literature focused on the aftermath of Hurricane Katrina, BP Deepwater Horizon oil spill, and urban communities. A photovoice project was conducted to measure causes and consequences of vulnerability and social resiliency by identifying sources of health strengths and health risks among individuals, families, and the community through generational and cultural perspectives. Content analysis was conducted to identify themes associated with vulnerability and resiliency and were subsequently grouped into six main categories. Findings will aid others exploring innovative approaches to addressing vulnerability and resiliency in underserved communities and applying photovoice as a research tool.

Associations of health belief and health literacy with Pap smear practice among Asian immigrant women.

PURPOSE: To examine associations of health belief and health literacy with Pap smear practice among Asian immigrant women in South Korea. METHODS: This study used a descriptive, cross-sectional study design. A survey was conducted among 196 migrant women who were married to South Korean men, using a questionnaire translated into English, Chinese, Vietnamese, and Korean. Trained research assistants read the questionnaire and the participants gave their answers. RESULTS: The most common birthplace of the immigrant women was Vietnam (43.0%), followed by China (12.2%) and the Philippines (5.6%). Of the participants, 76.5% answered that they had never had a Pap smear test. Multiple logistic regression analysis revealed that age and functional health literacy were associated with Pap smear practice among Asian immigrant women. With a one-year increase in participants' age, Pap smear practice increased 1.15 times (OR = 1.15, 95% CI: 1.07, 1.23). Furthermore, with a one point increase in functional health literacy, Pap smear practice increased 1.18 times (OR = 1.18, 95% CI: 1.02, 1.37). CONCLUSIONS: Results suggest that more information about Pap smear tests should be provided to young immigrant women. Health providers should be made aware that Pap smear practice among young immigrant women might be infrequent and should actively recommend that they receive the tests. To improve Pap smear practice among immigrant women, it is also crucial for educational strategies to include functional health literacy. Nurses could play an important role in explaining and recommending the Pap smear test through communication with immigrant women.

"Living happily despite having an illness": Perceptions of healthy aging among Korean American, Vietnamese American, and Latino older adults.

BACKGROUND/OBJECTIVE: The growingly diverse aging population presents a challenge for the geriatric workforce, particularly its capacity to effectively respond to the sociocultural and linguistic needs of ethnic minority older adults. Informed by research on the importance of culturally-competent care in reducing racial and ethnic health disparities, this study sought to understand the meaning of healthy aging from the perspectives of Korean American, Vietnamese American, and Latino older adults. METHODS: Interviews were conducted with 30 participants recruited from community-based organizations in Southern California. RESULTS: Several dimensions emerged in the participants' understanding of healthy aging: (1) having good physical and mental health (2) optimism and acceptance; (3) social connectedness; (4) taking charge of one's health; and (5) independence and self-worth. CONCLUSIONS: Results could inform the development of a culturally-responsive geriatric healthcare system that takes into account older adults' beliefs, preferences, and needs to promote successful aging.

Factors influencing health and safety practices among Vietnamese nail salon technicians and owners: A qualitative study.

OBJECTIVE: This qualitative study explored factors that influence health and safety practices among Vietnamese nail salon technicians and owners. METHODS: We conducted semi-structured focus group discussions and individual interviews with a sample of 17 Vietnamese nail salon technicians and owners in the Philadelphia metropolitan area, Pennsylvania. RESULTS: Analysis of transcripts revealed perceived health benefits/concerns, knowledge about work-related hazards, salon's management and policies attributed to owners, client influence, external policies/regulations, and protective equipment-specific challenges were among factors affecting workplace health promotion practices at the salons. CONCLUSIONS: The study highlighted a complex interplay among the various stakeholders including nail technicians, owners, clients, policy makers, and enforcers. Interventions addressing barriers at the personal and organizational levels, as well as public policy change and enforcement are needed to create sustainable behavioral and organizational change in nail salons.

Tobacco Smoking and Antisocial Deviance among Vietnamese, Vietnamese-American, and European-American Adolescents.

Tobacco smoking is one of the most significant modifiable behavioral health risk factors worldwide. Although smoking rates in some high-income countries (HIC) have declined, rates in many low-and-middle-income countries (LMIC) remain high. Adolescence is a key developmental risk period for smoking initiation. Research indicates that a major adolescent risk factor for tobacco smoking is antisocial deviance, which includes such behaviors as aggression, risk-taking, and rule-breaking. The linkages between antisocial deviance and smoking suggest that these behaviors and their underlying attitudes can be important targets for smoking prevention programs, but for public health efficiency it is important to target the components of antisocial deviance most closely linked smoking. However, although 80% of smokers live in LMIC, most relevant research has been conducted in HIC and its applicability to LMIC is unclear, given cultural differences between many HIC and LMIC. The purpose of the present study was to assess cross-cultural variations in relations among components of antisocial deviance and self-reported tobacco smoking among 2,724 10th and 11th grade Vietnamese, Vietnamese-American, and European-American students. Within the combined sample the relation between self-reported smoking and overall antisocial deviance was ß = 0.33. However, the component of antisocial deviance most strongly related to smoking varied across groups, with Risk-taking most strongly related to smoking for Vietnamese-American (ß = 0.37) and Vietnamese (ß = 0.36) adolescents, and Rule-breaking Behavior most strongly related to smoking for European-American (ß = 0.51) adolescents. These and other findings suggest the possible importance of culturally-tailored foci for smoking prevention programs emphasizing different aspects of antisocial deviance.

Volunteering among First-Generation Asian Ethnic Groups Residing in California.

This study was a cross-sectional investigation of volunteer activity among four distinct Asian ethnic subgroups-Chinese, Filipino, Korean, and Vietnamese-who have immigrated to the United States. Data from the 2011-2012 California Health Interview Survey (CHIS) were used with an analytic sample of Chinese (n = 547), Filipino (n = 229), Korean (n = 490), and Vietnamese (n = 546) adults 50 and older. A series of logistic regression models were estimated to examine differences and similarities across the four ethnic groups in volunteer activity. Consistent with previous studies, Asian immigrants with more years of education and those who became U.S. citizens were more likely to participate in volunteering. However, the correlates were not consistent within Asian ethnic subgroups. For example, education was not a significant factor for older Korean immigrants while it was a salient factor among other Asian subgroups. Results showed similarities and differences associated with volunteer participation among diverse ethnic subgroups. The findings underscored the importance of culture-specific information in creating inclusive opportunities for volunteering.

Improving the knowledge and behavior of workplace chemical exposures in Vietnamese-American nail salon workers: a randomized controlled trial.

OBJECTIVES: We assessed the efficacy of trainings with Vietnamese nail salon owners and workers on knowledge and behaviors that could reduce exposures to toxic chemicals in nail products. METHODS: We trained Vietnamese salon owners in California (n = 77) who then trained their workers (n = 200) on best practices. In a cluster randomized controlled trial, we assessed the efficacy of the training on change in knowledge and self-reported behaviors. Data were collected from 2013 to 2016 and analyzed from 2016 to 2017. RESULTS: Compared to the control group, the intervention group had significantly greater increases in knowledge about: safer nail polishes [odds ratio (OR) 3.7 (95% confidence interval (CI) 1.9, 7.2)]; proper ventilation methods (OR 4.2; 95% CI 2.2, 8.1); recommended glove types (OR 3.4; 95% CI 1.9, 6.3); and recommended product handling and storage (OR 4.1; 95% CI 1.7, 9.9). The intervention also increased best practices: using safer nail polishes (OR 3.6; 95% CI 1.9, 6.8); reading product labels (OR 2.6; 95% CI 1.3, 5.0); and wearing long sleeves (OR 2.4; 95% CI 1.3, 4.2). CONCLUSIONS: The owner-to-worker intervention with culturally and linguistically appropriate training for salon owners who then trained workers was effective in promoting knowledge and self-reported behaviors that can reduce workplace chemical exposures.

Culturally Sensitive Assessment of Anxious-Depressive Distress in Vietnam: Avoiding Category Truncation.

The present study investigated what complaints are prominent in psychologically distressed Vietnamese in Vietnam beyond standard symptoms assessed by Western diagnostic instruments for anxiety and depression. To form the initial Vietnamese Symptom and Cultural Syndrome Addendum (VN SSA), we reviewed the literature, consulted experts, and conducted focus groups. The preliminary VN SSA was then used in a general survey (N = 1004) of five provinces in Vietnam. We found that the VN SSA items were highly and significantly correlated with a measure of anxious-depressive psychopathology (a composite measure of the General Anxiety Disorder-7; Posttraumatic Diagnostic Scale; and Patient Health Questionnaire-9). The VN SSA item most highly correlated to anxious-depressive psychopathology was "thinking a lot" ( r = .54), reported by 15.8% of the sample. Many other symptoms in the addendum also were prominent, such as orthostatic dizziness (i.e., dizziness upon standing up; r = .41), reported by 22.9% of the sample. By way of comparison, somatic complaints more typically assessed to profile Western anxious-depressive distress, such as palpitations, were less prominent, as evidenced by being less strongly correlated to Western psychiatric symptoms and being less frequent (e.g., palpitations: r = .31, 7.1% of the sample). Study results suggest that to avoid category truncation when profiling anxious-depressive distress among Vietnamese that items other than those in standard psychopathology measures should also be assessed.

Preferences for Depression Help-Seeking Among Vietnamese American Adults.

Culture impacts help-seeking preferences. We examined Vietnamese Americans' help-seeking preferences for depressive symptoms, through a telephone survey (N = 1666). A vignette describing an age- and gender-matched individual with depression was presented, and respondents chose from a list of options and provided open-ended responses about their help-seeking preferences. Results showed that 78.3% would seek professional help, either from a family doctor, a mental health provider, or both; 54.4% preferred to seek help from a family doctor but not from a mental health provider. Most (82.1%) would prefer to talk to family or friends, 62.2% would prefer to look up information, and 50.1% would prefer to get spiritual help. Logistic regression analysis revealed that preferences for non-professional help-seeking options (such as talking to friends or family, looking up information, and getting spiritual help), health care access, and perceived poor health, were associated with increased odds of preferring professional help-seeking. This population-based study of Vietnamese Americans highlight promising channels to deliver education about depression and effective help-seeking resources, particularly the importance of family doctors and social networks. Furthermore, addressing barriers in access to care remains a critical component of promoting professional help-seeking.

Chinese, Vietnamese, and Asian Indian Parents' Perspectives About Well-Child Visits: A Qualitative Analysis.

OBJECTIVES: Well-child visits are a critical component of pediatric health care; however, disparities in attendance and quality of care exist for Asian children. Limited research has explored Asian immigrant parents' perspectives about their well-child visit experience. METHODS: Qualitative interviews were conducted with Chinese, Vietnamese, and Asian Indian immigrant parents. Participants were recruited from community-based organizations in the Boston area. Interviews focused on parents' perceptions about well-child visits, including individual attitudes, social and cultural factors affecting their opinions, perceived behavioral control, and improving visits for Asian immigrant families. Data were coded and analyzed using thematic analysis. RESULTS: Fifty-one parents participated. Although participants reported attending well-child visits, they thought language barriers and unfamiliarity with US preventive health care may limit attendance for other Asian immigrant families. Some reported high-quality visits, while others described them as "too simple," recollecting health care experiences from their countries of origin where more tests were completed. Participants described seeking advice about their children's preventive care from elder family members. Many expressed the importance of culturally concordant health care providers and culturally sensitive care, while others thought that culture was less relevant. Differences emerged among the 3 subgroups around culturally concordant care and traditional medicine. CONCLUSIONS: Querying parents about their past health care experiences and providing information about well-child visits may be useful when caring for immigrant families. Social influences on children's health outside of the parent-provider-child triad may also be important. Further work should explore how to deliver culturally sensitive care that considers not only a family's language preferences but also their unique cultural identity.

Vietnamese Oral Health Beliefs and Practices: Impact on the Utilization of Western Preventive Oral Health Care.

Purpose: Infrequent use of the Western health care by the Vietnamese may be explained by deeply-rooted traditional oral health beliefs and practices unique to the Asian culture. This study investigated Vietnamese oral health beliefs and practices and their relationship to the utilization of Western preventive oral health care services among Vietnamese-Americans.Methods: An exploratory, cross-sectional survey design with a convenience sample of 140 par-ticipants (n = 140) was used for this study. Participants were recruited on site of a Vietnamese-owned business, with questionnaires consisting of 28 questions that were distributed in hard copy by the principal investigator (PI) on multiple occasions and at various times of the day.Results: Spearman Rank Correlations tests showed participants who agreed with the statement, "Regular dental visits will help prevent dental problems," were more likely to utilize medical health services (p< 0.05) and visit a dentist if their "gums were bleeding" (p< 0.05). However, only 22.86% of the participants would visit a dentist if experiencing a toothache. Despite results showing a strong association between the use of medical health care services and the belief that dental visits can prevent future dental health problems, participants did not believe in seeking Western oral health care for all dental health issues. No statistical significance was found between age, gender, pri-mary language, years spent in the United States, education level, religion and the Vietnamese survey participants' individual oral beliefs and practices.Conclusion: The results suggest that Vietnamese Americans holding the belief that dental visits help prevent oral health problems, were more likely to utilize Western health care services. The study also supports existing literature that Vietnamese oral health beliefs and practices impact the use of Western health care services.

A Narrative Engagement Framework to Understand HPV Vaccination Among Latina and Vietnamese Women in a Planned Parenthood Setting.

Disparities in cervical cancer and human papillomavirus (HPV) vaccination persist among Vietnamese and Latina women. Through a partnership with Planned Parenthood of Orange and San Bernardino Counties (PPOSBC) in Southern California, we conducted in-depth interviews with young adult Latina ( n = 24) and Vietnamese ( n = 24) women, and PPOSBC staff ( n = 2). We purposively sampled vaccinated women to elicit HPV vaccine decision narratives to uncover rich data on motivators, cultural values, and implicit vaccine attitudes. Unvaccinated women were interviewed to identify barriers. Women were also asked to discuss their observations of men's HPV vaccine attitudes. Narrative engagement theory guided the study privileging the meaning women ascribed to their experiences and conversations related to vaccine decision making. Vaccine decision narratives included (a) mother-daughter narratives, (b) practitioner recommendation of HPV vaccination, (c) independence narratives among Vietnamese women, (d) HPV (un)awareness narratives, and (d) school exposure to HPV knowledge. Barriers to vaccinating included trust in partner HPV status, and family silence and stigma about sexual health. Participants conveyed the importance of including messages aimed at reaching men. Practitioners described insurance barriers to offering same day vaccination at PPOSBC health center visits. Narrative communication theory and methodology address health equity by privileging how Vietnamese and Latina women ascribe meaning to their lived experiences and conversations about HPV vaccination. Identifying authentic and relatable vaccine decision narratives will be necessary to effectively engage Vietnamese and Latina women. These findings will guide the process of adapting an existing National Cancer Institute research-tested HPV vaccine intervention.

Culturally Sensitive Care for Asian Immigrants: Home Healthcare Perspectives.

The number of Asian immigrants has risen dramatically in recent decades, making them the fastest growing immigrant group in the United States. Home healthcare clinicians are expected to meet the healthcare needs of patients regardless of their ethnic or cultural background, but this can be challenging without a basic understanding of the patient's culture. This article is intended to provide information about the cultural traditions and health conditions clinicians may encounter when caring for patients and families who have immigrated to the United States from the top five Asian countries as determined by the U.S. Census, and concludes with resources that home healthcare clinicians can utilize when engaging in patient education.

Immigrants' utilization of specialist mental healthcare according to age, country of origin, and migration history: a nation-wide register study in Norway.

PURPOSE: As the immigrant population rises in Norway, it becomes ever more important to consider the responsiveness of health services to the specific needs of these immigrants. It has been questioned whether access to mental healthcare is adequate among all groups of immigrants. This study aims to examine the use of specialist mental healthcare services among ethnic Norwegians and specific immigrants groups. METHODS: Register data were used from the Norwegian Patient Registry and Statistics Norway. The sample (age 0-59) consisted of 3.3 million ethnic Norwegians and 200,000 immigrants from 11 countries. Poisson regression models were applied to examine variations in the use of specialist mental healthcare during 2008-2011 according to country of origin, age group, reason for immigration, and length of stay. RESULTS: Immigrant children and adolescents had overall significantly lower use of specialist mental healthcare than ethnic Norwegians of the same age. A distinct exception was the high utilization rate among children and youth from Iran. Among adult immigrants, utilization rates were generally lower than among ethnic Norwegians, particularly those from Poland, Somalia, Sri Lanka, and Vietnam. Adult immigrants from Iraq and Iran, however, had high utilization rates. Refugees had high utilization rates of specialist mental healthcare, while labour immigrants had low use. CONCLUSION: Utilization rates of specialist mental healthcare are lower among immigrants than Norwegians. Immigrants from Poland, Somalia, Sri Lanka, and Vietnam, had generally quite low rates, while immigrants from Iran had high utilization rates. The findings suggest that specialist mental healthcare in Norway is underutilized among considerable parts of the immigrant population.

Identifying areas of need relative to liver disease: geographic clustering within a health service district.

Background Many people with chronic liver disease (CLD) are not detected until they present to hospital with advanced disease, when opportunities for intervention are reduced and morbidity is high. In order to build capacity and liver expertise in the community, it is important to focus liver healthcare resources in high-prevalence disease areas and specific populations with an identified need. The aim of the present study was to examine the geographic location of people seen in a tertiary hospital hepatology clinic, as well as ethnic and sociodemographic characteristics of these geographic areas. Methods The geographic locations of hepatology out-patients were identified via the out-patient scheduling database and grouped into statistical area (SA) regions for demographic analysis using data compiled by the Australian Bureau of Statistics. Results During the 3-month study period, 943 individuals from 71 SA Level 3 regions attended clinic. Nine SA Level 3 regions accounted for 55% of the entire patient cohort. Geographic clustering was seen especially for people living with chronic hepatitis B virus. There was a wide spectrum of socioeconomic advantage and disadvantage in areas with high liver disease prevalence. Conclusions The geographic area from which people living with CLD travel to access liver health care is extensive. However, the greatest demand for tertiary liver disease speciality care is clustered within specific geographic areas. Outreach programs targeted to these areas may enhance liver disease-specific health service resourcing. What is known about the topic? The demand for tertiary hospital clinical services in CLD is rising. However, there is limited knowledge about the geographic areas from which people living with CLD travel to access liver services, or the ethnic, socioeconomic and education characteristics of these areas. What does this paper add? The present study demonstrates that a substantial proportion of people living with CLD and accessing tertiary hospital liver services are clustered within specific geographic areas. The most striking geographic clustering was seen for people living with chronic hepatitis B, in regions with a relatively high proportion of people born in Vietnam and China. In addition to ethnicity, the data show an apparent ecological association between liver disease and both socioeconomic and educational and/or occupational disadvantage. What are the implications for practitioners? Identifying where demand for clinical services arises is an important step for service planning and preparing for potential outreach programs to optimise community-based care. It is likely that outreach programs to engage and enhance primary care services in geographic areas from which the greatest demand for tertiary liver disease speciality care arises would yield greater relative return on investment than non-targeted outreach programs.