• 10
    Dec
  • RACIAL DIFFERENCES IN HEPATITIS В AND HEPATITIS С: RESULTS

Population Characteristics

The final sample was 376 persons with SMI: 155 Caucasian and 221 African-American military veterans, of whom over 90% were men (see Table 1). Compared with Caucasians, African Americans were younger, a smaller proportion were currently married, and a greater proportion were institutionalized or homeless. There were no racial differ ences in educational status or having at least one child. A greater proportion of African Americans had a diagnosis of schizophrenia spectrum disorders and drug use disorders, fewer were diagnosed with PTSD or bipolar disorder, and a smaller proportion had experienced combat exposure. Over 40% of the study cohort had an alcohol use disorder, with no racial difference observed.

Table 1. Demographic Characteristics of Study Population, Shown by Race

Variable

Caucasians (n=155) Percent

African Americans (n=221) Percent

P

Age 50 or over

56.77

31.22

O.0001
Male

90.97

90.05

0.8594
Currently married

38.06

18.18

O.0001
Children: at least one

72.90

72.73

1.0000
Education level 0.4937
<High school

12.90

9.95

High school

20.65

24.89

>High school

66.45

65.16

Residence 0.0195
Independent or with family

87.10

81.00

Institutionalized or supervised

1.29

6.33

Homeless

3.23

7.24

Other

8.39

5.43

Psychiatric diagnosis O.0001
Schizophrenia

17.42

48.87

Schizoaffective

9.68

9.50

Bipolar

25.81

9.50

PTSD

47.10

32.13

HBV and HCV Infection Rates and Risk Factor Prevalence

For HBV, the overall seroprevalence rate was 21.3%. It was a new diagnosis for 65% (52 of 80) of the HBV-positive patients. African Americans had a higher HBV rate than did Caucasians: 27.6% versus 12.3%; OR=2.73; 95% CI=1.55,4.79 (Table 2). The overall HCV seroprevalence was 18.9%, and, for 56% (40 of 71) of the HCV-positive patients, it was a new diagnosis. The HCV rate was also higher in African Americans; although this difference was not statistically significant, a trend was observed: 21.3% versus 15.5%; OR=1.47; 95%CI=0.86,2.53.
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Table 2. Hepatitis В and С Prevalence Rates and Risk Factors, Shown by Race

Caucasians

African Americans 95%

Variable

(n=155)

(n=221)

Odds Ratio

Confidence

Percent

Percent Interval
HBV infected

12.26

27.60

2.73***

1.55, 4.79

HCV infected

15.48

21.27

1.47

0.86, 2.53

Combat exposure

62.99

51.13

0.61*

0.40, 0.94

Alcohol use disorder

40.65

42.99

1.10

0.73, 1.67

Drug use disorder

17.42

32.13

2.24**

1.36, 3.71

Drug/needle risks, lifetime IV
drug use

18.06

17.65

0.97

0.57, 1.66

Shared needles

11.61

13.57

1.20

0.64, 2.23

Smoked crack

25.16

61.82

4.82***

3.06, 7.58

Sniffed/snorted drugs

47.74

63.35

1.89**

1.25, 2.87

Type of unprotected sex, lifetime
Any type of sex

97.42

99.55

5.83

0.65, 52.65

Vaginal sex

97.42

99.10

2.90

0.52,16.04

Anal sex

24.03

21.82

0.88

0.54,1.44

Oral sex

70.78

68.78

0.91

0.58, 1.42

Sex for drugs

7.79

19.91

2.94**

1.50, 5.78

Sex for money/gifts

17.11

23.08

1.45

0.86, 2.46

Multiple sex partners
past six months

16.88

36.36

2.81***

1.70, 4.65

*p<0.05; **p<0.01; ***p<0.001

African Americans were also more likely to have a self-report of a drug use disorder than were Caucasians. No racial differences in lifetime IDU and sharing needles were observed. African Americans were significantly more likely than Caucasians to report smoking crack and sniffing or snorting drugs over their lifetime. Cialis Jelly

Among sexual risk behaviors, African Americans were more likely to report engaging in sex for drugs and were more likely than Caucasians to report having multiple sex partners in the past six months.

Table 3. Hepatitis В and С Logistic Regression Models

Hepatitis В Hepatitis С
Selected Risk Factors Adjusted Odds Ratio 95% Confidence Interval Adjusted Odds Ratio 95% Confidence Interval
African-American race 2 7^**

1.41, 5.53

1.52

0.61,3.79

Combat exposure 1.30

0.63, 2.67

1.10

0.41, 2.94

Psychiatric diagnosis*

Bipolar

PTSD

0.59 1.34 0.22, 1.60 0.66, 2.72 0.80 2.06 0.22, 2.97 0.78, 5.40
Currently married 1.67

0.83, 3.40

1.35

0.52, 3.48

Independent or live with family+t 0.82

0.39, 1.72

0.55

0.21, 1.44

IV drug use 4.54***

2.28, 9.04

40.53***

16.72, 98.24

Smoked crack cocaine 1.18

0.55, 2.54

5.20**

1.91, 14.17

Sniffed/snorted drugs 1.06

0.51, 2.21

0.68

0.25, 1.88

Unprotected sex for drugs 1.25

0.60, 2.61

0.97

0.38, 2.48

Multiple sex partners in past 6 months 2.01*

1.06, 3.78

0.75

0.31, 1.81

Alcohol use disorder 0.93

0.52, 1.69

1.24

0.57, 2.70

Age 50+ 1.27

0.67, 2.39

1.64

0.69, 3.95

*p<0.05; **p<0.01; ***p<0.001

Hepatitis В model: с statistic=0.74

Hepatitis С model: с statistic=0.91

+ Schizophrenia spectrum disorder reference group

t+ Homeless, Institutionalized, or Other reference group

Multivariable Analysis

After adjusting for other important factors, we found that African Americans continued to have a higher risk of testing positive for HBV: OR=2.79; 95% СU.41, 5.53 (see Table 3). Notably, the multi-variable analysis did not eliminate or weaken the association for race. Other factors also significantly associated with HBV seropositivity were IDU (OR=4.54; 95% CI=2.28, 9.04) and having multiple sex partners in the last six months (OR=2.01; 95% CI=1.06,3.78). In contrast, in the multivariable analysis, race was not significantly related to serostatus for HCV (OR=1.52; 95% CI=0.61, 3.79), but IDU (OR=40.53; 95% CI=16.72, 98.24) and use of crack cocaine (OR=5.20; 95% CI=1.91, 14.17) remained independent risk factors for HCV seropositivity.
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