Elevated prevalence of hepatitis C infection in users of United States Veterans medical centers
Elevated prevalence of hepatitis C infection in users of United States Veterans medical centers
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DOI：
10.1002/hep.20502
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发表时间：
2005-01-01
期刊：
影响因子：
13.5
通讯作者：
Sporleder, JL
中科院分区：
文献类型：
--
作者：
Dominitz, JA;Boyko, EJ;Sporleder, JL
几项研究表明，退伍军人的丙型肝炎病毒感染率高于非退伍军人，这可能是由于军事暴露。摘要本研究旨在评估退伍军人事务部医疗中心使用者之抗丙型肝炎抗体盛行率，并评估感染相关因素。使用两阶段聚类样本，随机选择的3,863名退伍军人中有1,288人完成了调查，并接受了家庭静脉切开术进行血清学检测。管理和临床数据用于校正未参与的患病率估计值。血清学受试者中抗丙型肝炎抗体的患病率为4.0%（95%CI，2.6%-5.5%）。在对参与者和非参与者之间的社会人口统计学和临床差异进行校正后，退伍军人事务部医疗中心用户人群的估计患病率为5.4%（95%CI，3.3%-7.5%）。血清阳性的重要预测因素包括人口统计学因素、服兵役时间（例如，越南时代）、先前诊断、卫生保健使用和生活方式因素。30.2%的受试者报告了至少一种传统风险因素（输血或静脉注射药物）。在丙型肝炎抗体检测呈阳性的人中，78%的人曾输血或使用过注射药物。调整注射吸毒和不参与，血清阳性与纹身和监禁。在调整后的分析中，未发现与军事有关的暴露与感染有关。总之，这些受试者中丙型肝炎的患病率超过美国普通人群的估计值2倍以上，这可能反映了这些退伍军人更多地暴露于传统风险因素。
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, 1,288 of 3,863 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 anti-hepatitis 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.