Socioeconomic status in HCV infected patients - risk and prognosis

Background and aims: It is unknown whether socioeconomic status (SES) is a risk factor for hepatitis C virus (HCV) infection or a prognostic factor following infection.

Methods: FROM DANISH NATIONWIDE REGISTRIES, WE OBTAINED INFORMATION ON THREE MARKERS OF SES: employment, income, and education. In a case control design, we examined HCV infected patients and controls; conditional logistic regression was employed to obtain odds ratios (ORs) for HCV infection for each of the three SES markers, adjusting for the other two SES markers, comorbidity, and substance abuse. In a cohort design, we used Cox regression analysis to compute mortality rate ratios (MRRs) for each of the three SES markers, adjusting for the other two SES markers, comorbidity level, age, substance abuse, and gender.

Results: When compared to employed persons, ORs for HCV infection were 2.71 (95% confidence interval [CI]: 2.24-3.26) for disability pensioners and 2.24 (95% CI: 1.83-2.72) for the unemployed. When compared to persons with a high income, ORs were 1.64 (95% CI: 1.34-2.01) for low income persons and 1.19 (95% CI: 1.02-1.40) for medium income persons. The OR was 1.35 (95% CI: 1.20-1.52) for low education (no more than basic schooling). When compared to employed patients, MRRs were 1.71 (95% CI: 1.22-2.40) for unemployed patients and 2.24 (95% CI: 1.63-3.08) for disability pensioners. When compared to high income patients, MRRs were 1.47 (95% CI: 1.05-2.05) for medium income patients and 1.64 (95% CI: 1.13-2.34) for low income patients. Educational status was not associated with mortality.

Conclusion: Low SES was associated with an increased risk of HCV infection and with poor prognosis in HCV infected patients.