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Risk Factors for Hepatitis C Infection Among Vietnam Era Veterans Versus Nonveterans: Results from the Chronic Hepatitis Cohort Study (CHeCS)

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Abstract

Research suggests that Vietnam era veterans have a higher prevalence of hepatitis C virus (HCV) than other veterans and nonveterans. However, the reasons for this are unclear, since this research has been conducted among Department of Veterans Affairs (VA) patients and most veterans do not use the VA. The current study compares HCV risk factors between the Vietnam era veterans and nonveterans seen in 4 large non-VA systems to explain this disparity. A total of 4,636 HCV patients completed surveys in 2011–2012. Vietnam era veterans were defined as those who served in the military any time between 1964 and 1975. Bivariate tests followed by logistic regressions, and multivariable modeling were conducted to study risk factors among Vietnam era veterans and nonveterans. Since few veterans were female (~2 %), they were excluded. Among male respondents (N = 2,638), 22.5 % were classified as Vietnam era veterans. Compared to nonveterans, these patients were older (p < 0.001), more educated (p < 0.001), less often foreign born (p = 0.009), more often married (p < 0.001), less often employed, and less likely to have a history of drug abuse treatment (p < 0.001). Comparison of specific risk factor differences for HCV infection by veteran status suggested that while injection drug use approached statistical significance (nonveterans = 46.1 % vs. Vietnam era veterans = 41.4 %, p = 0.06), only reported sex with men was significant (nonveterans = 2.4 % vs. Vietnam era veterans = 0.6 %, p = 0.013). In multivariate logistic regression controlling for age, education, country of birth, marital status and study site, no HCV risk factor was associated with Vietnam era veteran status. However, veterans were more likely to report “other” exposures were the source of infection than nonveterans (p < 0.001). While Vietnam era veterans seen in non-VA facilities do not report a higher prevalence of common HCV risk factors, such as injection drug use, they are more likely to report “other” exposures, typically associated with military service, as the source of HCV infection.

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Acknowledgments

CHeCS is funded by the CDC Foundation, which currently receives grants from AbbVie, Janssen Pharmaceuticals, Inc., and Vertex Pharmaceuticals. Past funders include Genentech, a Member of the Roche Group. Current and past partial funders include Gilead Sciences and Bristol-Myers Squibb. Granting corporations did not have access to the CHeCS data and did not contribute to data analysis or writting of the manuscripts.

Conflict of interest

Stuart C. Gordon receives grant/research support from AbbVie Pharmaceuticals, Bristol-Myers Squibb, Gilead Pharmaceuticals, GlaxoSmithKline, Intercept Pharmaceuticals, Merck, and Vertex Pharmaceuticals. He is also a consultant for Amgen, Bristol-Myers Squibb, CVS Caremark, Gilead Pharmaceuticals, Merck, Novartis, and Vertex and is on the Data Monitoring Board for Janssen Pharmaceuticals. The other authors have no conflict of interests associated with this research study.

Ethical standard

The investigation followed the guidelines of the U.S. Department of Health and Human Services regarding protection of human subjects. The study protocol was approved and renewed annually by each participating institution’s institutional review board.

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Authors and Affiliations

  1. Geisinger Health System, Danville, PA, USA

    Joseph A. Boscarino

  2. Henry Ford Health System, Detroit, MI, USA

    Alexandra Sitarik, Stuart C. Gordon, Loralee B. Rupp, David R. Nerenz & Mei Lu

  3. Kaiser Permanente-Hawaii, Honolulu, HI, USA

    Vinutha Vijayadeva

  4. Kaiser Permanente-Northwest, Portland, OR, USA

    Mark A. Schmidt & Emily Henkle

  5. Center for Health Research, Geisinger Clinic, 100 N. Academy Avenue, M.C. 44-00, Danville, PA, 17822, USA

    Joseph A. Boscarino

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  1. Joseph A. Boscarino
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  2. Alexandra Sitarik
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  3. Stuart C. Gordon
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  4. Loralee B. Rupp
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  5. David R. Nerenz
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  6. Vinutha Vijayadeva
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  7. Mark A. Schmidt
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  8. Emily Henkle
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  9. Mei Lu
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Correspondence to Joseph A. Boscarino.

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For the CheCS investigators.

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Boscarino, J.A., Sitarik, A., Gordon, S.C. et al. Risk Factors for Hepatitis C Infection Among Vietnam Era Veterans Versus Nonveterans: Results from the Chronic Hepatitis Cohort Study (CHeCS). J Community Health 39, 914–921 (2014). https://doi.org/10.1007/s10900-014-9863-5

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  • DOI: https://doi.org/10.1007/s10900-014-9863-5

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