RACIAL DIFFERENCES IN HEPATITIS В AND HEPATITIS С: DISCUSSION
This is the first study to assess racial differences in HBV and HCV infection rates and self-reported behavioral risks among veterans with SMI, a very high-risk subpopulation. Overall, the prevalence of both these infections was high. Over half of these infections were newly diagnosed; thus, most veterans were unaware of the infection. African Americans had higher rates of both HBV and HCV than did Caucasians. This difference was statistically significant for HBV, and a similar trend was observed for HCV There was no significant racial difference observed in this sample for lifetime IDU. However, several drug- and sex-risk behaviors were reported significantly more often in African Americans than in Caucasians, specifically, smoking crack, sniffing or snorting drugs over their lifetime, unprotected sex for drugs in their lifetime, and multiple sex partners in the past six months. These observations are consistent with findings on high-risk sexual behavior reported for the general population. The rates of hepatitis infections in veterans with SMI are much higher than those reported in the general population for both races and across similar age groupings.
After controlling for potential confounding sex-and drug-risk variables, as well as psychiatric diagnosis, combat exposure, and selected demographics variables, we found that African-American race continued to be a significant factor for HBV infection. In addition, IDU and multiple sex partners also remained associated with HBV infection. African-American race was not significantly associated with HCV seropositivity after we adjusted for other variables. Of the sex- and drug-risk variables, crack and IDU remained significantly associated with HCV seropositivity in the logistic regression. You can afford your medication buy your aricept drug online
The racial difference in psychiatric diagnosis observed in our cohort (e.g., higher rates of schizophrenia in African-American veterans and of PTSD in Caucasian veterans) warrants discussion, although it does not account for the racial differences in hepatitis infection rates. The racial differences in diagnosis may be due to differences in treatment-seeking patterns for the veterans in our service area and may reflect the largely urban and minority characteristic of the surrounding community. The area the Durham VA serves is urban, and over half the patients seeking services are African Americans. A large study of HCV-infected veterans found that 86% had a comorbid psychiatric or substance use disorder; PTSD was a risk factor for HCV in these veterans, whereas psychosis was not. Thus, we would expect that, if there were a racial bias in our diagnosis, it would minimize the racial difference in these infections rather than increase it. Of note, there were higher rates of combat exposure among Caucasians in this sample, and PTSD diagnoses were confirmed by the self-report symptom checklist. Alternatively, racial bias in diagnosing psychotic spectrum disorders more frequently in African Americans than in Caucasians can occur in clinical and research settings. It is hypothesized that clinician or screening-instrument bias contributes to a misdiagnosis of SMIs in African Americans. Errors in psychiatric diagnoses may also be related to cultural insensitivities in traditional mental health systems, clinician prejudice, or to ethnic differences in the ways that patients express emotional distress and psychotic symptoms. African Americans with PTSD may endorse more psychotic symptoms without higher rates of primary psychosis than do Caucasians, leading to an underdiagnosis or misdiagnosis of PTSD in African-American veterans. Rates of service connection for veterans with PTSD are substantially lower for African Americans than they are for other veterans, a finding that persists after the authors adjusted for differences in PTSD severity and functional status. This racial disparity may lead to less access to psychiatric services for African Americans with PTSD and contribute to fewer African Americans in the PTSD group in this study, which warrants further research. viagra soft tabs online
Our results are consistent with studies that report higher rates of HCV infection and HBV infection in minority populations, although we noted only a trend toward higher rates of HCV infection. In our model, race continued to be significantly related to an increase in HBV-positive serostatus after we adjusted for other known risk factors. Similarly, our results lend support to research linking African-American race to a num ber of independent risk factors for HBV infection, such as increased number of sexual partners and cocaine use. HBV risks, however, could be mediated through social and contextual factors such as poverty, neighborhood exposure, or lifestyle choices not measured here and perhaps not attributable to the construct of race. A plausible reason for the higher rates in African Americans is a potential difference in baseline prevalence rates of HBV within social networks; hence, exposure rates could vary between different groups. For example, we did not evaluate the study participants on the basis of the neighborhoods in which they reside, which has been shown to explain some of the racial variance in crack use. Alternatively, some undefined risk factor may account for the higher rate in African-American veterans. There may be racial differences in susceptibility to HBV, which has been reported for other infections, e.g., tuberculosis, malaria, and for the clearance of HCV In summary, the relative frequencies and patterns of HBV risks in the different racial groups and the baseline prevalence rates among exposure groups may explain the prevalence differences that we observed.
Although the prevalence of several risk behaviors demonstrates clear racial differences, the actual risks of HCV transmission were similar for African Americans and Caucasians. Overall, IDU posed the greatest risk for HCV in this cohort, which supports the findings of other studies and extends those findings to a high-risk subpopulation, veterans with SMI. Our ability to control for several factors—particularly IDU—is an important strength of our study, compared with earlier work. The significant risk of smoking crack cocaine and HCV infection, however, remained after we adjusted for IDU in the HCV model. Although this finding is divergent from prior studies, it is consistent with recent reports. One of those reports of crack cocaine users, most of whom were African-American men, also found high rates of HCV (33%). Over a third of the HCV-positive patients, however, denied any lifetime IDU. The authors concluded that other cocaine-related factors outside of its parenteral use might be related to the high rates observed in their cohort. A higher prevalence of crack cocaine use among African Americans than among Caucasians is consistent with other population studies of patterns of drug use in the United States. generic cialis soft tabs