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Clin Gastroenterol Hepatol. 2019 Aug 5. pii: S1542-3565(19)30845-6. doi: 10.1016/j.cgh.2019.07.056. [Epub ahead of print]

Prevalence of Hepatitis B Virus Exposure in the Veterans Health Administration and Association With Military-related Risk Factors.

Author information

1
General Medicine Service, and Health Services Research and Development, Veterans Affairs Puget Sound Health Care System; Division of General Internal Medicine, University of Washington School of Medicine (Seattle, WA, USA). Electronic address: lauren.beste@va.gov.
2
Gastroenterology Service, and Health Services Research and Development, Veterans Affairs Puget Sound Health Care System; Division of Gastroenterology, University of Washington School of Medicine (Seattle, WA, USA).
3
Gastroenterology Service, Portland Veterans Affairs Medical Center; Division of Gastroenterology, Oregon Health and Sciences University (Portland, OR, USA).
4
Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System (Seattle, WA, USA).
5
General Medicine Service, and Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System; Division of General Internal Medicine, University of Washington School of Medicine (Seattle, WA, USA).
6
Seattle Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System (Seattle, WA, USA).
7
Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System; Department of Epidemiology, University of Washington (Seattle, WA, USA).
8
Health Services Research and Development, Veterans Affairs Puget Sound Health Care System; Health Services Department, University of Washington School of Public Health (Seattle, WA, USA).
9
Office of Specialty Care Services, Veterans Health Administration, Department of Veterans Affairs (Washington, D.C., USA).
10
Gastroenterology Section, and Health Services Research and Development, Veterans Affairs Puget Sound Health Care System; Division of Gastroenterology, University of Washington School of Medicine (Seattle, WA, USA).

Abstract

BACKGROUND & AIMS:

Military veterans were reported to have higher odds of hepatitis B virus (HBV) exposure after adjustment for demographic factors, family income, and birthplace. It is not clear whether military-related exposures are associated with risk of HBV exposure in veterans.

METHODS:

A random sample of veterans receiving care from 1998 through 2000 in the national Veterans' Health Administration system completed a risk factor survey and underwent phlebotomy analysis (n=1146). Stored serum samples were reanalyzed to determine prevalence of HBV exposure (core antibody positive), infection (surface antigen or DNA positive), and immunity (surface antibody positive, surface antigen and core antibody negative). Associations between military-related risk factors and HBV exposure were assessed using logistic regression.

RESULTS:

The prevalence values for infection, exposure, and immunity were 0.7% (95% CI, 0.3-1.5), 13.6% (95% CI, 11.5-16.1), and 6.2% (95% CI, 4.7-8.2), respectively. Evidence of HBV exposure was highest among respondents with traditional risk factors (such as drug use or high-risk sexual practices). More than half the individuals with HBV exposure (53%) reported no history of traditional risk factors; of these, 59.5% reported a history of combat exposure. After adjustment for demographic and traditional risk factors, service in a combat zone (adjusted odds ratio,1.56; 95% CI, 1.01-2.41) and being wounded in combat (adjusted odds ratio, 1.79; 95% CI, 1.04-3.08) were independently associated with exposure to HBV.

CONCLUSIONS:

In an analysis of United States military veterans, we found the prevalence of exposure to HBV to be highest among veterans with traditional risk factors but also independently related to military combat or being wounded in combat. Studies are needed to determine whether veterans with combat exposure prior to the era of universal vaccination should be screened for HBV exposure.

KEYWORDS:

cirrhosis risk factor; epidemiology; population; soldier

PMID:
31394284
DOI:
10.1016/j.cgh.2019.07.056
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