title: Significant disparities in risks of diabetes mellitus and metabolic syndrome among chronic hepatitis C virus patients in the U.S.
abstract: OBJECTIVE
  Diabetes mellitus (DM) and metabolic syndrome (MetSyn) among chronic hepatitis C virus (HCV) patients increases risks for nonalcoholic fatty liver disease (NAFLD) and more rapid progression to hepatocellular carcinoma (HCC). We aim to evaluate the prevalence of DM and MetSyn among HCV patients, focusing on age-specific and race/ethnicity-specific disparities.
  
  
  METHODS
  We retrospectively evaluated 2003-2012 National Health and Nutrition Examination Survey (NHANES) data for age and race disparities in concurrent DM and MetSyn among HCV patients. Multivariate logistic regression models evaluated for independent predictors of DM and MetSyn among HCV patients.
  
  
  RESULTS
  Overall U.S. prevalence of HCV was 1.29% from 2003 to 2012 and prevalence of DM and MetSyn among HCV patients was 17.5% and 35.0%, respectively. Higher rates of DM (36.9% vs. 3.3%, p<0.001) and MetSyn (50.5% vs. 11.7%, p<0.001) were seen among HCV patients ≥60 compared to <40years. The highest rates of DM and MetSyn were seen among African Americans (AA) (DM: 39.1%, MetSyn: 29.2%) and the lowest in non-Hispanic whites (DM: 9.4%, MetSyn: 33.0%). On multivariate regression, patients ≥60 were significantly more likely to have DM compared to patients <40 years (OR 11.90, 95% CI 2.73-52.60, p=0.001); AA were significantly more likely to have DM compared to non-Hispanic whites (OR 2.82, 95% CI 1.53-5.20, p=0.001).
  
  
  CONCLUSIONS
  Among chronic HCV patients, the highest risk of DM and MetSyn was seen among older patients, African Americans, and women. These groups are at higher risk of cirrhosis and HCC due to concurrent NAFLD.
authors.affiliation: Division of Gastroenterology and Hepatology, Alameda Health System-Highland Hospital, Oakland, CA, United States.
authors.forename: Darnna E
authors.initials: DE
authors.lastname: Banks
authors.affiliation: Department of Medicine, Alameda Health System-Highland Hospital, Oakland, CA, United States.
authors.forename: Yael
authors.initials: Y
authors.lastname: Bogler
authors.affiliation: Division of Gastroenterology and Hepatology, Alameda Health System-Highland Hospital, Oakland, CA, United States.
authors.forename: Taft
authors.initials: T
authors.lastname: Bhuket
authors.affiliation: Division of Gastroenterology and Hepatology, Alameda Health System-Highland Hospital, Oakland, CA, United States.
authors.forename: Benny
authors.initials: B
authors.lastname: Liu
authors.affiliation: Division of Gastroenterology and Hepatology, Alameda Health System-Highland Hospital, Oakland, CA, United States. Electronic address: Rowong@alamedahealthsystem.org.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Wong
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D016174:Hepacivirus / Q000472:pathogenicity*; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000821:virology; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology / Q000209:etiology*; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Hepatocellular carcinoma; NHANES; Nonalcoholic fatty liver disease; Obesity; Racial disparities