Risk factors for hepatitis C infection among adult patients in Kedah state, Malaysia: A case–control study

Autoři: Mohd Azri Mohd Suan aff001;  Salmiah Md Said aff001;  Poh Ying Lim aff001;  Ahmad Zaid Fattah Azman aff001;  Muhammad Radzi Abu Hassan aff002
Působiště autorů: Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia aff001;  Clinical Research Centre, Ministry of Health Malaysia, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia aff002;  Department of Medicine, Ministry of Health Malaysia, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia aff003
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224459


Hepatitis C infection is a global public health problem. This study was designed to identify the risk factors associated with hepatitis C infection among adult patients in Kedah state, Malaysia. A matched, hospital-based, case–control study was conducted at a tertiary hospital. Cases were adult (aged ≥ 18 years) patients with positive serology test results for hepatitis C virus antibody and detectable hepatitis C virus RNA from January 2015 to December 2018, and controls were age-, sex- and ethnicity-matched patients who were not infected with hepatitis C virus. Self-administered questionnaires were used to collect data on demographic characteristics and previous exposure to selected risk factors among the study participants. Associations between hepatitis C and demographic and risk factors were assessed using univariable and multivariable logistic regression analyses. A total of 255 case–control patient pairs were enrolled. The multivariable analysis indicated that having a history of blood or blood product transfusion before 1992 (adjusted odds ratio [AOR] = 6.99, 95% confidence interval [CI]: 3.73–13.81), injection drug use (AOR = 6.60, 95% CI: 3.66–12.43), imprisonment (AOR = 4.58, 95% CI: 1.62–16.40), tattooing (AOR = 3.73, 95% CI: 1.37–12.00), having more than one sexual partner (AOR = 2.06, 95% CI: 1.16–3.69), piercing (AOR = 1.71, 95% CI: 1.04–2.80), and having only secondary education (AOR = 1.92, 95% CI: 1.06–3.57) were independently associated with hepatitis C. No associations were found between health care occupation, needle-prick injury, surgical procedures, haemodialysis, acupuncture, cupping, or contact sports and hepatitis C infection. These findings demonstrate that hepatitis C risk is multifactorial. Having a history of blood or blood product transfusion before 1992, injection drug use, imprisonment, tattooing, having more than one sexual partner, piercing, and having only secondary education were associated with increased odds of hepatitis C.

Klíčová slova:

Blood – Blood transfusion – Drug users – Hepatitis C – Hepatitis C virus – Malaysia – Medical risk factors – Surgical and invasive medical procedures


1. World Health Organization. Global hepatitis report. 2017. Geneva: World Health Organization; 2017. Available from: http://www.who.int/hepatitis/publications/global-hepatitis-report2017/en/.

2. Omata M, Kanda T, Wei L, Yu M-L, Chuang W-L, Ibrahim A, et al. APASL consensus statements and recommendations for hepatitis C prevention, epidemiology, and laboratory testing. Hepatol Int. 2016;10: 681–701. doi: 10.1007/s12072-016-9736-3 27229718

3. Stanaway JD, Flaxman AD, Naghavi M, Fitzmaurice C, Vos T, Abubakar I, et al. The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013. Lancet. 2016;388: 1081–1088. doi: 10.1016/S0140-6736(16)30579-7 27394647

4. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385: 117–171. doi: 10.1016/S0140-6736(14)61682-2 25530442

5. Gower E, Estes C, Blach S, Razavi-Shearer K, Razavi H. Global epidemiology and genotype distribution of the hepatitis C virus infection. J Hepatol. 2014;61: S45–57. doi: 10.1016/j.jhep.2014.07.027 25086286

6. Ministry of Health Malaysia. Health indicators 2005–2010. Putrajaya: Ministry of Health Malaysia; 2016. Available from: http://vlib.moh.gov.my/cms/content.jsp?id=com.tms.cms.section.Section_2e3f7260-a0188549-d5315d00-3572f8b1.

7. Ministry of Health Malaysia. Health indicators 2011–2017. Putrajaya: Ministry of Health Malaysia; 2017. Available from: http://vlib.moh.gov.my/cms/content.jsp?id=com.tms.cms.section.Section_2e3f7260-a0188549-d5315d00-3572f8b1.

8. Ministry of Health Malaysia. Health facts 2018. Putrajaya: Ministry of Health Malaysia; 2018. Available from: http://www.moh.gov.my/index.php/pages/view/58?mid=19

9. Lim SG, Aghemo A, Chen PJ, Dan YY, Gane E, Gani R, et al. Management of hepatitis C virus infection in the Asia-Pacific region: An update. Lancet Gastroenterol Hepatol. 2017;2: 52–62 doi: 10.1016/S2468-1253(16)30080-2 28404015

10. Hiebert L, Hecht R, Soe-Lin S, Mohamed R, Shabaruddin FH, Syed Mansor SM, et al. A Stepwise Approach to a National Hepatitis C Screening Strategy in Malaysia to Meet the WHO 2030 Targets: Proposed Strategy, Coverage, and Costs. Value Health Reg Issues. 2019;18: 112–120. doi: 10.1016/j.vhri.2018.12.005 30921591

11. Vicknasingam B, Narayanan S, Navaratnam V. Prevalence rates and risk factors for hepatitis C among drug users not in treatment in Malaysia. Drug Alcohol Rev. 2009;28: 447–454. doi: 10.1111/j.1465-3362.2009.00087.x 19594801

12. Tan WL, Yihui G, Abu Hassan MR. Demographic characteristics and intravenous drug use among hepatitis C patients in the Kota Setar district, Kedah, Malaysia. Epidemiol Health. 2015;37: e2015032. doi: 10.4178/epih/e2015032 26212507

13. Jaafar R, Isahak I, Wong K, Rashid ZZ, Sulong A, Jaafar M, et al. Prevalence and predisposing factors for hepatitis C virus in haemodialysis unit Universiti Kebangsaan Malaysia Medical Centre. BMC Proc. 2011;5: P210.

14. Choo MKK, El-Bassel N, Adam PCG, Gilbert L, Wu E, West BS, et al. Prevalence and correlates of HIV and hepatitis C virus infections and risk behaviors among Malaysian fishermen. PloS One. 2015;10: e0118422. doi: 10.1371/journal.pone.0118422 26244844

15. Ng KP, Saw TL, Wong NW, Goh KL, Chuah SY, Nagaratnam M. The prevalence of anti-HCV antibody in risk groups and blood donors. Med J Malaysia. 1995;50: 302–305. 8668047

16. Tan SS, Adlin Nadia Z. The clinical features and treatment outcome of chronic hepatitis C with pegylated interferon and ribavirin in routine care. Med J Malaysia. 2017;72: 165–174. 28733564

17. Siti NFA, Hairul AH, Hadzri H. Study of hepatitis C virus infection at a tertiary hospital: Genotyping, risk factors and comorbidities. Int Med J Malaysia. 2017;16: 11–20.

18. Tan SS, Menon J, Radzi M, Thein S, Rosmawati M, Annuar S. The Demography and Risk Profiles for Chronic Hepatitis B and C from the Malaysian Liver Registry. Med J Malaysia. 2011;66: 31.

19. Duraisamy G. Blood transfusion service in Malaysia. Jpn J Transfus Med. 1994;40: 776–778.

20. Karmochkine M, Carrat F, Dos Santos O, Cacoub P, Raguin G. A case-control study of risk factors for hepatitis C infection in patients with unexplained routes of infection. J Viral Hepat. 2006;13: 775–782. doi: 10.1111/j.1365-2893.2006.00742.x 17052278

21. Fleiss J. Statistical methods for rates and proportions. 2nd ed. New York, NY: John Wiley; 1981.

22. Kuo C-L, Duan Y, Grady J. Unconditional or conditional logistic regression model for age-matched case–control data? Front Public Health. 2018;6: 57. doi: 10.3389/fpubh.2018.00057 29552553

23. Hosmer DW, Lemeshow S. Applied logistic regression. 2nd ed. New York: Wiley & Sons, Inc; 2002.

24. Team RC. R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2014.

25. Paez Jimenez A, Mohamed MK, Eldin NS, Seif HA, El Aidi S, Sultan Y, et al. Injection drug use is a risk factor for HCV infection in urban Egypt. PLoS One. 2009;4: e7193. doi: 10.1371/journal.pone.0007193 19784363

26. Kandeel AM, Talaat M, Afifi SA, El-Sayed NM, Abdel Fadeel MA, Hajjeh RA, et al. Case control study to identify risk factors for acute hepatitis C virus infection in Egypt. BMC Infect Dis. 2012;12: 294. doi: 10.1186/1471-2334-12-294 23145873

27. Sun J, Yu R, Zhu B, Wu J, Larsen S, Zhao W. Hepatitis C infection and related factors in hemodialysis patients in China: Systematic review and meta-analysis. Ren Fail. 2009;31: 610–620. doi: 10.1080/08860220903003446 19839861

28. Zhang T, Tully DC, Zhou S, He N. Characteristics of HCV co-infection among HIV infected individuals from an area with high risk of blood-borne infections in Central China. PLoS One. 2014;9: e94219. doi: 10.1371/journal.pone.0094219 24709894

29. National Anti-Drugs Agency Malaysia. Drugs statistics. Kuala Lumpur: National Anti-Drugs Agency Malaysia; 2018. Available from: https://www.adk.gov.my/en/public/drugs-statistics/.

30. Norliza C, Norni A, Anandjit S, Mohd Fazli MI. A review of substance abuse research in Malaysia. Med J Malaysia. 2014;69: 55–58. 25417952

31. Granados-García V, Flores YN, Díaz-Trejo LI, Méndez-Sánchez L, Liu S, Salinas-Escudero G, et al. Estimating the prevalence of hepatitis C among intravenous drug users in upper middle income countries: A systematic review and meta-analysis. PloS One. 2019;14: e0212558. doi: 10.1371/journal.pone.0212558 30807590

32. Roose RJ, Cockerham-Colas L, Soloway I, Batchelder A, Litwin AH. Reducing barriers to hepatitis C treatment among drug users: An integrated hepatitis C peer education and support program. J Health Care Poor Underserved. 2014;25: 652–662. doi: 10.1353/hpu.2014.0096 24858874

33. World Health Organization. Prison and Health. Denmark: World Health Organization Reginal Office for Europe; 2014. Available from: https://apps.who.int/iris/bitstream/10665/128603/1/PrisonandHealth.pdf

34. Moazen B, Saeedi Moghaddam S, Silbernagl MA, Lotfizadeh M, Bosworth RJ, Alammehrjerdi Z, et al. Prevalence of Drug Injection, Sexual Activity, Tattooing, and Piercing Among Prison Inmates. Epidemiol Rev. 2018;40: 58–69. doi: 10.1093/epirev/mxy002 29860343

35. Walmsley, R. World Prison Population List 12th Edition. 2018. Institute for Criminal Policy Research: World Prison Brief; 2018. Available from: https://www.prisonstudies.org/research-publications

36. Russell M, Chen M-J, Nochajski TH, Testa M, Zimmerman SJ, Hughes PS. Risky sexual behavior, bleeding caused by intimate partner violence, and hepatitis C virus infection in patients of a sexually transmitted disease clinic. Am J Public Health. 2009;99: S173–179. doi: 10.2105/AJPH.2007.126383 19218181

37. Sohn H-S, Kim JR, Ryu SY, Lee Y-J, Lee MJ, Min HJ, et al. Risk factors for hepatitis C virus (HCV) infection in areas with a high prevalence of HCV in the Republic of Korea in 2013. Gut Liver. 2016;10: 126–132. doi: 10.5009/gnl14403 26260752

38. Westermann C, Peters C, Lisiak B, Lamberti M, Nienhaus A. The prevalence of hepatitis C among healthcare workers: A systematic review and meta-analysis. Occup Environ Med. 2015;72: 880–888. doi: 10.1136/oemed-2015-102879 26438666

Článek vyšel v časopise


2019 Číslo 10