Elevated prevalence of hepatitis C infection in users of United States veterans medical centers.
Several studies suggest veterans have a higher prevalence of hepatitis C virus infection than nonveterans, possibly because of military exposures. The purpose of this study was to estimate the prevalence of anti-hepatitis C antibody and evaluate factors associated with infection among users of Department of Veterans Affairs medical centers. Using a two-staged cluster sample, 1288 of 3863 randomly selected veterans completed a survey and underwent home-based phlebotomy for serological testing. Administrative and clinical data were used to correct the prevalence estimate for nonparticipation. The prevalence of antihepatitis C antibody among serology participants was 4.0% (95% CI, 2.6%-5.5%). The estimated prevalence in the population of Veterans Affairs medical center users was 5.4% (95% CI, 3.3%-7.5%) after correction for sociodemographic and clinical differences between participants and nonparticipants. Significant predictors of seropositivity included demographic factors, period of military service (e.g., Vietnam era), prior diagnoses, health care use, and lifestyle factors. At least one traditional risk factor (transfusion or intravenous drug use) was reported by 30.2% of all subjects. Among those testing positive for hepatitis C antibody, 78% either had a transfusion or had used injection drugs. Adjusting for injection drug use and nonparticipation, seropositivity was associated with tattoos and incarceration. Military-related exposures were not found to be associated with infection in the adjusted analysis. In conclusion, the prevalence of hepatitis C in these subjects exceeds the estimate from the general US population by more than 2-fold, likely reflecting more exposure to traditional risk factors among these veterans.
Dominitz
Jason A
JA
Epidemiologic Research and Information Center VA Puget Sound Health Care System, Seattle, WA 98108-1597, USA. jason.dominitz@med.va.gov
Boyko
Edward J
EJ
Koepsell
Thomas D
TD
Heagerty
Patrick J
PJ
Maynard
Charles
C
Sporleder
Jennifer L
JL
Stenhouse
Andrew
A
Kling
Mitchel A
MA
Hrushesky
William
W
Zeilman
Charles
C
Sontag
Stephen
S
Shah
Nikunj
N
Ona
Fernando
F
Anand
Bhupinder
B
Subik
Marc
M
Imperiale
Thomas F
TF
Nakhle
Samer
S
Ho
Sam B
SB
Bini
Edmund J
EJ
Lockhart
Bruce
B
Ahmad
Jawad
J
Sasaki
Anna
A
van der Linden
Brian
B
Toro
Doris
D
Martinez-Souss
Jaime
J
Huilgol
Vivek
V
Eisen
Seth
S
Young
Keith A
KA
D000328:Adult; D000368:Aged; D001803:Blood Transfusion; D003430:Cross-Sectional Studies; D005260:Female; D006526:Hepatitis C / Q000453:epidemiology* / Q000209:etiology; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011330:Prisons; D012307:Risk Factors; D015819:Substance Abuse, Intravenous; D011795:Surveys and Questionnaires; D013653:Tattooing; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data*