title: Elevated prevalence of hepatitis C infection in users of United States veterans medical centers.
abstract: 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.
authors.affiliation: Epidemiologic Research and Information Center VA Puget Sound Health Care System, Seattle, WA 98108-1597, USA. jason.dominitz@med.va.gov
authors.forename: Jason A
authors.initials: JA
authors.lastname: Dominitz
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Boyko
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Koepsell
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Heagerty
authors.forename: Charles
authors.initials: C
authors.lastname: Maynard
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Sporleder
authors.forename: Andrew
authors.initials: A
authors.lastname: Stenhouse
authors.forename: Mitchel A
authors.initials: MA
authors.lastname: Kling
authors.forename: William
authors.initials: W
authors.lastname: Hrushesky
authors.forename: Charles
authors.initials: C
authors.lastname: Zeilman
authors.forename: Stephen
authors.initials: S
authors.lastname: Sontag
authors.forename: Nikunj
authors.initials: N
authors.lastname: Shah
authors.forename: Fernando
authors.initials: F
authors.lastname: Ona
authors.forename: Bhupinder
authors.initials: B
authors.lastname: Anand
authors.forename: Marc
authors.initials: M
authors.lastname: Subik
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Imperiale
authors.forename: Samer
authors.initials: S
authors.lastname: Nakhle
authors.forename: Sam B
authors.initials: SB
authors.lastname: Ho
authors.forename: Edmund J
authors.initials: EJ
authors.lastname: Bini
authors.forename: Bruce
authors.initials: B
authors.lastname: Lockhart
authors.forename: Jawad
authors.initials: J
authors.lastname: Ahmad
authors.forename: Anna
authors.initials: A
authors.lastname: Sasaki
authors.forename: Brian
authors.initials: B
authors.lastname: van der Linden
authors.forename: Doris
authors.initials: D
authors.lastname: Toro
authors.forename: Jaime
authors.initials: J
authors.lastname: Martinez-Souss
authors.forename: Vivek
authors.initials: V
authors.lastname: Huilgol
authors.forename: Seth
authors.initials: S
authors.lastname: Eisen
authors.forename: Keith A
authors.initials: KA
authors.lastname: Young
mesh_terms: 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*