Session number: 1059
Abstract title: Racial Differences in Hepatitis B and C and Associated Risks in Veterans with Severe Mental Illness
Author(s):
MI Butterfield - Durham VA, HSR&D and Duke University Dept. of Psychiatry
HB Bosworth - Durham VA, HSR&D and Duke University Depts. of Psychiatry and Medicine
KM Stechuchak - Durham VA, HSR&D
KG Meador - Durham VA, HSR&D and Duke University Dept. of Psychiatry
LA Bastian - Durham VA, HSR&D and Duke University Dept. of Medicine
MS Swartz - Duke University Dept. of Psychiatry
RD Horner - Durham VA, ERIC and Duke University Medical Center
Objectives: Racial differences in the rates of HBV and HCV infections are known for the general population but not high-risk subpopulations such as veterans with severe mental illness (SMI). We assessed racial differences in the seroprevalence of, and risks for, HBV and HCV in veterans with SMI.
Methods: We enrolled 376 veterans (155 white, 221 black) from the Durham VA psychiatric inpatient unit between 1998 and 2000. All had schizophrenia, schizoaffective disorder, bipolar I disorder, or posttraumatic stress disorder. HBV and HCV serostatus were determined through standard assays, and risk behaviors were ascertained through a validated structured risk interview. Using HBV and HCV serostatus as primary outcome variables, we performed unadjusted and adjusted analyses.
Results: The prevalence of HBV infection was 27.6% for blacks vs. 12.26 % for whites (OR=2.73; CI=1.55,4.79). For HCV, 21.27% of blacks were infected vs.15.48 % of whites (OR=1.47; CI= 0.86,2.53). No racial differences in injection drug use (IDU), the strongest risk indicator for both HBV- and HCV-positive serostatus, were observed. Blacks, however, were more likely than whites to have ever smoked crack (OR= 4.82; CI = 3.06,7.58), sniffed/snorted drugs (OR=1.89; CI =125, 2.87), have a drug use disorder (OR=2.24; CI=1.36,3.71), engaged in sex for drugs (OR= 2.94; CI=1.50,5.78) or have had multiple sex partners during the past 6 months (OR= 2.81; CI=1.70,4.65). For HBV, multivariable analyses indicated that black race, IDU, and having multiple sex partners in the past 6 months were related to an increased risk. In contrast, for HCV, IDU and smoking crack cocaine, but not race, were independently related to an increased risk.
Conclusions: Racial differences exist in several HBV and HCV risk behaviors among veterans with SMI. Blacks have higher prevalence rates of HBV than whites, an association that continued to exist after adjusting for other factors. Although nonsignificant, elevated rates of HCV were also found in blacks.
Impact statement: The VA strategic initiative on HCV calls for epidemiological screening. Veterans with SMI constitute a high-risk group who should be routinely screened for both HCV and HBV. VA prevention strategies incorporating racial differences in risks for these infections are warranted.