Prevalence of Hepatitis C virus infection in a sample of homeless veterans

被引:41
作者
Desai, RA
Rosenheck, RA
Agnello, V
机构
[1] Yale Univ, Sch Med, NE Program Evaluat Ctr 182, VA Connecticut Healthcare Syst,Dept Psychiat, West Haven, CT 06516 USA
[2] Lahey Clin Fdn, Burlington, MA USA
[3] Edith Norse Rogers Mem Vet Affairs Hosp, Boston, MA USA
关键词
Hepatitis C; homelessness; veterans; substance abuse; prevalence studies;
D O I
10.1007/s00127-003-0639-y
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
Objective: This study measures the prevalence of Hepatitis C Virus (HCV) infection in a sample of homeless veterans treated in a Domiciliary Care for Homeless Veterans (DCHV) program in Massachusetts. We also examine risk factors and correlates for HCV infection, including substance abuse and service in Vietnam. Methods: Patients admitted to the DCHV program over a 5-year period (n=418) were systematically tested for HCV infection. Blood test data were merged with standardized data collection forms to assess socio-demographic characteristics, military history, and medical and psychiatric history. Results: The overall prevalence rate of HCV infection was 44.02%, a rate more than ten times higher than the national rate for men age 20-59 and more than twice as high as other VA patient samples. Adjusting for age, significant risk factors in this sample included a history of substance abuse (OR=6.86, p<0.0001) and service during the Vietnam era (OR=4.66, p=0.01). Comparisons of the tested sample with other homeless veterans treated in 34 similar programs nationally indicated that this sample did not significantly differ from other treated homeless veterans with respect to demographics or HCV risk factors. Conclusions: We found a high prevalence of HCV infection in this population that is not likely to be geographically unique, and may indicate particularly high risk for homeless men. Substance abuse is the most important risk factor, and we hypothesize that the effect of Vietnam-era service is a proxy for unreported drug use. We advise an increase in screening and education for all homeless populations, particularly those with a history of injection drug use. Public systems of care, including the VA, should expect increasing costs of care related to HCV infection as prevalent cases develop serious medical sequelae of HCV infection.
引用
收藏
页码:396 / 401
页数:6
相关论文
共 23 条
[1]   The prevalence of hepatitis C virus infection in the United States, 1988 through 1994 [J].
Alter, MJ ;
Kruszon-Moran, D ;
Nainan, OV ;
McQuillan, GM ;
Gao, FX ;
Moyer, LA ;
Kaslow, RA ;
Margolis, HS .
NEW ENGLAND JOURNAL OF MEDICINE, 1999, 341 (08) :556-562
[2]   RISK-FACTORS FOR ACUTE NON-A, NON-B HEPATITIS IN THE UNITED-STATES AND ASSOCIATION WITH HEPATITIS-C VIRUS-INFECTION [J].
ALTER, MJ ;
HADLER, SC ;
JUDSON, FN ;
MARES, A ;
ALEXANDER, WJ ;
HU, PY ;
MILLER, JK ;
MOYER, LA ;
FIELDS, HA ;
BRADLEY, DW ;
MARGOLIS, HS .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1990, 264 (17) :2231-2235
[3]  
[Anonymous], 1998, MMWR Recomm Rep, V47, P1
[4]  
[Anonymous], STATISTICS
[5]  
BAKER SL, 1971, B NEW YORK ACAD MED, V47, P541
[6]   Chronic hepatitis C: Effect of alcohol on hepatitic activity and viral titre [J].
Cromie, SL ;
Jenkins, PJ ;
Bowden, DS ;
Dudley, FJ .
JOURNAL OF HEPATOLOGY, 1996, 25 (06) :821-826
[7]   ANTIBODY TO HEPATITIS-C VIRUS AMONG CARDIAC-SURGERY PATIENTS, HOMOSEXUAL MEN, AND INTRAVENOUS-DRUG-USERS IN BALTIMORE, MARYLAND [J].
DONAHUE, JG ;
NELSON, KE ;
MUNOZ, A ;
VLAHOV, D ;
RENNIE, LL ;
TAYLOR, EL ;
SAAH, AJ ;
COHN, S ;
ODAKA, NJ ;
FARZADEGAN, H .
AMERICAN JOURNAL OF EPIDEMIOLOGY, 1991, 134 (10) :1206-1211
[8]  
DUFOUR MC, 1994, NIH PUBLICATION, P615
[9]   PREVALENCE OF HEPATITIS-C IN A CHEMICALLY DEPENDENT POPULATION [J].
FINGERHOOD, MI ;
JASINSKI, DR ;
SULLIVAN, JT .
ARCHIVES OF INTERNAL MEDICINE, 1993, 153 (17) :2025-2030
[10]   The treatment of chronic viral hepatitis [J].
Hoofnagle, JH ;
DiBisceglie, AM .
NEW ENGLAND JOURNAL OF MEDICINE, 1997, 336 (05) :347-356