Risk behaviours associated with hepatitis C infection: application of a syndemic effects framework in NHANES

Authors

  • Sinisa Stefanac Institute of Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna
  • Sandra Haider Medical University of Vienna
  • Thomas E Dorner Medical University of Vienna
  • Daragh T McDermott School of Social Sciences, Nottingham Trent University
  • Petre Cristian Ilie Research and Innovation Department, The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust

Keywords:

Hepatitis C Virus, Syndemic, Intravenous Drug Use, Risk, Disparity

Abstract

Objectives: To apply syndemic theory to investigate the risk of hepatitis C virus (HCV) infection in the US population.

Methods: National representative data were from the National Health and Nutrition Examination Survey. We extracted and aggregated data on HCV antibody test, sociodemographic characteristics, alcohol and drug use, depression, sexual behaviour and sexually transmitted illnesses from 2005-2006 to 2011-2012. The study sample was restricted to men and women aged 20-59 years given the upper age limit of the risk factors used for the analysis.

Results: Overall, 11,593 people were included in the analysis (52.2% female). Higher prevalence of HCV, excessive alcohol consumption and drug use were found in men. Men also had higher odds of HCV in comparison to women among younger (20-39 years old) OR 1.37 (95%CI 1.36-1.37) and middle-aged adults (40-59 years old) OR 2.04 (95%CI 2.03-2.04). Among younger adults, non-Hispanic black and Hispanic people were found to have a lower likelihood of testing positive, OR 0.35 (95%CI 0.35-0.35) and OR 0.30 (95%CI 0.30-0.30), respectively. However, in the middle-aged adults non-Hispanic black people were found to have a higher likelihood of testing positive OR 1.45 (95%CI 1.45-1.46). Analysis showed that for each additional risk factor associated with HCV infection there is an additional increase in the risk OR 1.55 (95%CI 1.55-1.55).

Conclusions: For every additional risk factor for HCV a person is exposed to, the overall risk of HCV increases.

References

Ditah I, Ditah F, Devaki P, Ewelukwa O, Ditah C, Njei B, et al. The changing epidemiology of hepatitis C virus infection in the United States: National Health and Nutrition Examination Survey 2001 through 2010. J Hepatol. 2014;60(4):691-698. https://doi.org/10.1016/j.jhep.2013.11.014

Rosenberg ES, Rosenthal EM, Hall EW, Barker L, Hofmeister MG, Sullivan PS, et al. Prevalence of Hepatitis C Virus Infection in US States and the District of Columbia, 2013 to 2016. JAMA Netw Open. 2018;1(8):e186371. https://doi.org/10.1016/j.jhep.2013.11.014

Westbrook RH, Dusheiko G. Natural history of hepatitis C. J Hepatol. 2014;61(1 Suppl):S58-68. https://doi.org/10.1016/j.jhep.2014.07.012

Centers for Disease Control. National Progress Report 2020 Goal: Reduce the rate of hepatitis C-related deaths to 4.17 per 100,000 population. [Internet]. 2018 [cited 2021 January 9]. Available from: https://www.cdc.gov/hepatitis/policy/NationalProgressReport-HepC-ReduceDeaths.htm

Liang TJ, Rehermann B, Seeff LB, Hoofnagle JH. Pathogenesis, natural history, treatment, and prevention of hepatitis C. Ann Intern Med. 2000;132(4):296-305. https://doi.org/10.7326/0003-4819-132-4-200002150-00008

American Association for the Study of Liver Diseases, Infectious Diseases Society of America. Recommendations for testing, management, and treating hepatitis C. HCV testing and linkage to care. [Internet]. 2017 [cited 2021 January 9]. Available from: http://www.hcvguidelines.org

Nyamathi AM, Dixon EL, Robbins W, Smith C, Wiley D, Leake B, et al. Risk factors for hepatitis C virus infection among homeless adults. J Gen Intern Med. 2002;17(2):134-143. https://doi.org/10.1046/j.1525-1497.2002.10415.x

Dan C. Hepatitis C Disparities among African Americans. [Internet]. 2017 [cited 2021 January 9]. Available from: https://www.hhs.gov/hepatitis/blog/2017/02/27/hepatitis-c-disparities-among-african-americans.html

Centers for Disease Control. Viral Hepatitis Surveillance - United States 2016. Centers for Disease Control and Prevention;2018.

Zibbell JE, Asher AK, Patel RC, Kupronis B, Iqbal K, Ward JW, et al. Increases in Acute Hepatitis C Virus Infection Related to a Growing Opioid Epidemic and Associated Injection Drug Use, United States, 2004 to 2014. Am J Public Health. 2018;108(2):175-181. https://doi.org/10.2105/AJPH.2017.304132

Williams IT, Bell BP, Kuhnert W, Alter MJ. Incidence and transmission patterns of acute hepatitis C in the United States, 1982-2006. Arch Intern Med. 2011;171(3):242-248. https://doi.org/10.1001/archinternmed.2010.511

Lieber CS. Alcohol and Hepatitis C. [Internet]. 2020 [cited 2021 January 9] Available from: https://pubs.niaaa.nih.gov/publications/arh25-4/245-254.htm

Gorgos L. Sexual transmission of viral hepatitis. Infect Dis Clin North Am. 2013;27(4):811-836. https://doi.org/10.1016/j.idc.2013.08.002

Kutalek R, Jirovsky E, Grabovac I. From macro- to microfactors in health: Social science approaches in research on sexually transmitted infections. PLoS Med. 2018;15(1):e1002490. https://doi.org/10.1371/journal.pmed.1002490

Singer M, Bulled N, Ostrach B, Mendenhall E. Syndemics and the biosocial conception of health. The Lancet. 2017;389(10072):941-950. https://doi.org/10.1016/S0140-6736(17)30003-X

Milstein B. Seeing Syndemics: Thoughts on Improving Public Health in Communities Challenged by Multiple Afflictions. [Internet]. 2002 [cited 2021 January 9]. Available from: https://www2.cdc.gov/syndemics/PPT/Syndemics%20Seminar%20NCCDPHP%20071802%20(web).ppt

Butt ZA, Shrestha N, Wong S, Kuo M, Gesink D, Gilbert M, et al. A syndemic approach to assess the effect of substance use and social disparities on the evolution of HIV/HCV infections in British Columbia. PLoS One. 2017;12(8):e0183609. https://doi.org/10.1371/journal.pone.0183609

McKee G, Butt ZA, Wong S, Salway T, Gilbert M, Wong J, et al. Syndemic Characterization of HCV, HBV, and HIV Co-infections in a Large Population Based Cohort Study. EClinicalMedicine. 2018;4:99-108. https://doi.org/10.1016/j.eclinm.2018.10.006

Perlman DC, Jordan AE. The Syndemic of Opioid Misuse, Overdose, HCV, and HIV: Structural-Level Causes and Interventions. Curr HIV/AIDS Rep. 2018;15(2):96-112. https://doi.org/10.1007/s11904-018-0390-3

Centers for Disease Control. National Health and Nutrition Examination Survey - 2005-2006 Data Documentation, Codebook, and Frequencies. [Internet]. 2009 [cited 2021 January 9]. Available from: https://wwwn.cdc.gov/Nchs/Nhanes/2005-2006/HEPC_D.htm

Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. Journal of general internal medicine. 2001;16(9):606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x

Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhnert WL, Alter MJ. The Prevalence of Hepatitis C Virus Infection in the United States, 1999 through 2002Hepatitis C Virus Infection in the United States. Annals of Internal Medicine. 2006;144(10):705-714. https://doi.org/10.7326/0003-4819-144-10-200605160-00004

FIRTHLOGIT: Stata module to calculate bias reduction in logistic regression [computer program]. 2015.

Harper I, Parker M. The politics and anti-politics of infectious disease control. Med Anthropol. 2014;33(3):198-205. https://doi.org/10.1080/01459740.2014.892484

Van Handel MM, Rose CE, Hallisey EJ, Kolling JL, Zibbell JE, Lewis B, et al. County-Level Vulnerability Assessment for Rapid Dissemination of HIV or HCV Infections Among Persons Who Inject Drugs, United States. J Acquir Immune Defic Syndr. 2016;73(3):323-331. https://doi.org/10.1097/QAI.0000000000001098

Edlin BR, Carden MR, Ferrando SJ. Managing Hepatitis C in Users of Illicit Drugs. Curr Hepat Rep. 2007;6(2):60-67. https://doi.org/10.1007/s11901-007-0005-8

Sylvestre DL, Loftis JM, Hauser P, Genser S, Cesari H, Borek N, et al. Co-occurring Hepatitis C, substance use, and psychiatric illness: treatment issues and developing integrated models of care. J Urban Health. 2004;81(4):719-734. https://doi.org/10.1093/jurban/jth153

Walsh JL, Fielder RL, Carey KB, Carey MP. Changes in women's condom use over the first year of college. J Sex Res. 2013;50(2):128-138. https://doi.org/10.1080/00224499.2011.642024

Denniston MM, Jiles RB, Drobeniuc J, Klevens RM, Ward JW, McQuillan GM, et al. Chronic hepatitis C virus infection in the United States, National Health and Nutrition Examination Survey 2003 to 2010. Ann Intern Med. 2014;160(5):293-300. https://doi.org/10.7326/M13-1133

Becker JB, Hu M. Sex differences in drug abuse. Front Neuroendocrinol. 2008;29(1):36-47. https://doi.org/10.1016/j.yfrne.2007.07.003

S Smith BD, Morgan RL, Beckett GA, Falck-Ytter Y, Holtzman D, Teo CG, et al. Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945-1965. MMWR Recomm Rep. 2012;61(RR-4):1-32.

Barocas JA, Tasillo A, Eftekhari Yazdi G, Wang J, Vellozzi C, Hariri S, et al. Population-level Outcomes and Cost-Effectiveness of Expanding the Recommendation for Age-based Hepatitis C Testing in the United States. Clin Infect Dis. 2018;67(4):549-556. https://doi.org/10.1093/cid/ciy098

The National Academies of Sciences EaM. A National Strategy for the Elimination of Hepatitis B and C. Washington, DC. 2016.

Forde KA, Tanapanpanit O, Reddy KR. Hepatitis B and C in African Americans: current status and continued challenges. Clin Gastroenterol Hepatol. 2014;12(5):738-748. https://doi.org/10.1016/j.cgh.2013.06.006

Downloads

Published

2021-04-05

How to Cite

Stefanac, S., Haider, S., Dorner, T., McDermott, D., & Ilie, P. (2021). Risk behaviours associated with hepatitis C infection: application of a syndemic effects framework in NHANES. Atena Journal of Public Health, 3, 5. Retrieved from https://atenajournals.com/ajph/article/view/37

Issue

Section

Articles