Journal of Community Health

, Volume 39, Issue 5, pp 914–921 | Cite as

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

  • Joseph A. BoscarinoEmail author
  • Alexandra Sitarik
  • Stuart C. Gordon
  • Loralee B. Rupp
  • David R. Nerenz
  • Vinutha Vijayadeva
  • Mark A. Schmidt
  • Emily Henkle
  • Mei Lu
Original Paper


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.


Veterans Hepatitis C Cohort study Risk factors Injection drug use 



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.


  1. 1.
    Armstrong, G. L., Wasley, A., Simard, E. P., McQuillan, G. M., Kuhnert, W. L., & Alter, M. J. (2006). The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Annals of Internal Medicine, 144, 705–714.PubMedCrossRefGoogle Scholar
  2. 2.
    Mitchell, A. E., Colvin, H. M., & Beasley, R. P. (2010). Institute of medicine recommendations for the prevention and control of hepatitis B and C. Hepatology, 51, 729–733.PubMedCrossRefGoogle Scholar
  3. 3.
    Moorman, A. C., Holmberg, S. D., Marlowe, S. I., et al. (1999). Changing conditions and treatments in a dynamic cohort of ambulatory HIV patients: The HIV outpatient study (HOPS). Annals of Epidemiology, 9, 349–357.PubMedCrossRefGoogle Scholar
  4. 4.
    Moorman, A. C., Gordon, S. C., Rupp, L. B., et al. (2013). Baseline characteristics and mortality among people in care for chronic viral hepatitis: The chronic hepatitis cohort study. Clinical Infectious Diseases, 56, 40–50.PubMedCrossRefGoogle Scholar
  5. 5.
    Spradling, P. R., Rupp, L., Moorman, A. C., et al. (2012). Hepatitis B and C virus infection among 1.2 million persons with access to care: Factors associated with testing and infection prevalence. Clinical Infectious Diseases, 55, 1047–1055.PubMedCrossRefGoogle Scholar
  6. 6.
    Dominitz, J. A., Boyko, E. J., Koepsell, T. D., et al. (2005). Elevated prevalence of hepatitis C infection in users of United States veterans medical centers. Hepatology, 41, 88–96.PubMedCrossRefGoogle Scholar
  7. 7.
    Briggs, M. E., Baker, C., Hall, R., et al. (2001). Prevalence and risk factors for hepatitis C virus infection at an urban veterans administration medical center. Hepatology, 34, 1200–1205.PubMedCrossRefGoogle Scholar
  8. 8.
    Yee, H. S., Chang, M. F., Pocha, C., et al. (2012). Update on the management and treatment of hepatitis C virus infection: Recommendations from the Department of Veterans Affairs Hepatitis C Resource Center Program and the National Hepatitis C Program Office. American Journal of Gastroenterology, 107, 669–689.PubMedCrossRefGoogle Scholar
  9. 9.
    Cheung, R. C. (2000). Epidemiology of hepatitis C virus infection in American veterans. American Journal of Gastroenterology, 95, 740–747.PubMedCrossRefGoogle Scholar
  10. 10.
    Brau, N., Bini, E. J., Shahidi, A., et al. (2002). Prevalence of hepatitis C and coinfection with HIV among United States veterans in the New York City metropolitan area. American Journal of Gastroenterology, 97, 2071–2078.PubMedGoogle Scholar
  11. 11.
    Mishra, G., Sninsky, C., Roswell, R., Fitzwilliam, S., & Hyams, K. C. (2003). Risk factors for hepatitis C virus infection among patients receiving health care in a Department of Veterans Affairs hospital. Digestive Diseases and Sciences, 48, 815–820.PubMedCrossRefGoogle Scholar
  12. 12.
    Calore, B. L., Cheung, R. C., & Giori, N. J. (2012). Prevalence of hepatitis C virus Infection in the veteran population undergoing total joint arthroplasty. The Journal of Arthroplasty, 27(10), 1772–1776.Google Scholar
  13. 13.
    Gary, C. (2009). A race against time: Hepatitis C diagnosis and treatment. The VVA Veteran. 29(5): 37–38. Accessed 3/9/2014.
  14. 14.
    Hunt, C. F. (2004). Relationship between immunization with jet injectors and hepatitis C infection as it relates to service connection. Washington, DC: Department of Veterans Affairs, Veterans Benefits Administration:1–2.Google Scholar
  15. 15.
    Tohme, R. A., & Holmberg, S. D. (2012). Transmission of hepatitis C virus infection through tattooing and piercing: A critical review. Clinical Infectious Diseases, 54, 1167–1178.PubMedCrossRefGoogle Scholar
  16. 16.
    Tohme, R. A., & Holmberg, S. D. (2010). Is sexual contact a major mode of hepatitis C virus transmission? Hepatology, 52, 1497–1505.PubMedCrossRefGoogle Scholar
  17. 17.
    US Department of Veterans Affairs. (2002). 2001 National Survey of Veterans (NSV): Final report. Washington, DC: US Department of Veterans Affairs.Google Scholar
  18. 18.
    Boscarino, J. A. (2007). Vietnam veterans, postwar experiences and health outcomes. In G. Fink (Ed.), Encyclopedia of stress (2nd ed., Vol. 3, pp. 830–838). New York, NY: Academic Press.CrossRefGoogle Scholar
  19. 19.
    US Department of Veterans Affairs. (2010). National Survey of Veterans, Active Duty Services Members, Demobilized National Guard and Reserve Members, Family Members, and Surviving Spouses. Final Report ed. Washington, DC: Department of Veterans Affairs.Google Scholar
  20. 20.
    Centers for Disease Control and Prevention (CDC). (2013). Locations and reasons for initial testing for hepatitis C infection—chronic hepatitis cohort study, United States, 2006–2010. MMWR. Morbidity and Mortality Weekly Report, 62, 645–648.Google Scholar
  21. 21.
    Roselle, G. A., Danko, L. H., Kralovic, S. M., Simbartl, L. A., & Kizer, K. W. (2002). National hepatitis C surveillance day in the Veterans Health Administration of the Department of Veterans Affairs. Military Medicine, 167, 756–759.PubMedGoogle Scholar
  22. 22.
    Groves, R. M., Fowler, F. J., Couper, M. P., Lepkowski, J. M., Singer, E., & Tourangeau, R. (2009). Survey methodology (2nd ed.). New York, NY: Wiley.Google Scholar
  23. 23.
    Ware, J. E., Kosinski, M., Turner-Bowker, D. M., & Gandek, B. (2001). How to Score the SF-8 Health Survey. Boston, MA: Quality metric incorporated; Health Assessment Lab.Google Scholar
  24. 24.
    Harrell, F. E. (2001). Regression modeling strategies: With applications to linear models, logistic regression, and survival analysis. New York, NY: Springer.Google Scholar
  25. 25.
    Robins, L. N. (1974). The Vietnam drug user returns. Washington, DC: U.S. Government Printing Office.Google Scholar
  26. 26.
    Kulka, R. A., Schlenger, W. E., Fairbank, J. A., et al. (1990). The national Vietnam veterans readjustment study: Tables of findings and technical appendices. New York, NY: Brunner/Mazel.Google Scholar
  27. 27.
    Boscarino, J. (1979). Current drug involvement among vietnam and non-Vietnam veterans. American Journal of Drug and Alcohol Abuse, 6, 301–312.PubMedCrossRefGoogle Scholar
  28. 28.
    US Department of Veterans Affairs. (2014). Hepatitis C: Military-related blood exposures, risk factors, VA care. Accessed 3/9, 2014.

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Joseph A. Boscarino
    • 1
    • 5
    Email author
  • Alexandra Sitarik
    • 2
  • Stuart C. Gordon
    • 2
  • Loralee B. Rupp
    • 2
  • David R. Nerenz
    • 2
  • Vinutha Vijayadeva
    • 3
  • Mark A. Schmidt
    • 4
  • Emily Henkle
    • 4
  • Mei Lu
    • 2
  1. 1.Geisinger Health SystemDanvilleUSA
  2. 2.Henry Ford Health SystemDetroitUSA
  3. 3.Kaiser Permanente-HawaiiHonoluluUSA
  4. 4.Kaiser Permanente-NorthwestPortlandUSA
  5. 5.Center for Health ResearchGeisinger ClinicDanvilleUSA

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