Hepatitis C risk factors in a Cambodian American population in Lowell, Massachusetts
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BACKGROUND: Hepatitis C (HCV) is the most common chronic blood-borne infection in the US5,6 and has life-threatening complications.10,11,18,27,44 HCV rates in Cambodian Americans are as high as national rates,5,11,22,37,41 but the transmission risks for Cambodians in the US are unclear. Rates of drug use, the most common national transmission risk,3,6,21 are not as high in this population.14,21 With the second largest population of Cambodians nationally, Lowell, Massachusetts12,19 provides a unique opportunity to study the risk factors associated with HCV transmission. OBJECTIVE: The objective of this study is to examine the risk factors associated with HCV in Cambodian Americans. The hypothesis is that HCV infected Cambodian Americans will have different rates of the United States Preventive Services Task Force (USPSTF) recognized risk factors compared to HCV infected non-Cambodian Americans.28 METHODS: This is a cross sectional study of HCV infected Cambodian and non-Cambodian Americans. Medical record data were abstracted for adults with reactive HCV antibody or RNA virus testing at Lowell Community Health Center (LCHC) between 2009 and 2012. Information regarding USPSTF-designated HCV risk factors was collected, and a comparison was made of HCV risk factors between infected Cambodian and non-Cambodian Americans. RESULTS: Cambodian Americans with HCV (n=128) were older (mean age 53 vs. 43 years old) and less likely to be male (41%) than the non-Cambodian group (67% male, n=541). Cambodians had far lower rates of overall recreational drug use (2.3% vs. 82.1%) and intravenous drug use (1.6% vs. 33.6%). The predominant HCV risk factor in Cambodians was birth between 1945 and 1965, while that for non-Cambodians was drug use. CONCLUSION: Most HCV infected Cambodian Americans treated at LCHC between 2009 and 2012 lacked any history of drug use. In contrast, the major risk factor for HCV infected non-Cambodian Americans treated at LCHC was drug use, consistent with the major risk factor for HCV transmission nationwide.3,6,21 This suggests that the current major HCV risk factors fail to describe how this virus was transmitted to Cambodian Americans who seek care at LCHC.