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Edward L. Murphy, MD, MPH; Stephen Bryzman, PA, MPH; Alan E. Williams, PhD; Harvey Co-Chien, MS; George B. Schreiber, DSc; Helen E. Ownby, PhD; Ronald O. Gilcher, MD; Steven H. Kleinman, MD; Lauri Matijas, MS; Ruth A. Thomson, MPH; George J. Nemo, PhD; REDS Investigators; A. E. Williams, PhD; C. Nass, PhD; H. Ownby, PhD; D. Waxman, MD; S. Kleinman, MD; S. Hutching; J. Fridey, MD; E. L. Murphy, MD, MPH; M. P. Busch, MD, MPH; R. O. Gilcher, MD; J. W. Smith, MD; G. B. Schrieber; R. Thomson, MPH; G. J. Nemo, PhD; T. Zuck, LLB, MD

JAMA. 1996;275(13):995-1000.

Abstract
Objective.
—To measure demographic determinants of hepatitis C virus (HCV) seroprevalence among blood donors in the United States.

Design.
—Cross-sectional epidemiological study.

Setting.
—Five blood centers in different regions of the United States.

Subjects.
—A total of 862 398 consecutive volunteer blood donors with one or more nonautologous donations from March 1992 through December 1993.

Methods.
—Demographic data collection, serological screening with second-generation anti-HCV enzyme immunoassay, and confirmation with anti-HCV recombinant immunoblot.

Results.
—There were 3126 donors with at least one blood donation confirmed HCV-seropositive, for a crude prevalence of 3.6 per 1000. Age-specific HCV sero-prevalence rose from 0.5 per 1000 in donors younger than 20 years to a maximum of 6.9 per 1000 in donors aged 30 to 39 years and declined in older age groups. There was interaction between age and educational attainment, with 30- to 49-year-olds with less than a high school diploma at highest risk of HCV infection (odds ratio [OR], 33.0; 95% confidence interval [CI], 23.0 to 47.2 compared with those younger than 30 years with a bachelor's degree or higher degree). Other independent risk factors for HCV seropositivity included male sex (OR, 1.9; 95% CI, 1.8 to 2.1), black race (OR, 1.7; 95% CI, 1.6 to 1.9), Hispanic ethnicity (OR, 1.3; 95% CI, 1.1 to 1.5), previous blood transfusion (OR, 2.8; 95% CI, 2.5 to 3.1), and first/only time donor status (OR, 4.2; 95% CI, 3.9 to 4.5, compared with repeat donors). Seropositivity for human T-lymphotropic virus types I and II, human immunodeficiency virus, or hepatitis B core antigen was highly associated with HCV seropositivity (OR, 10.4; 95% CI, 9.6 to 11.4 for one vs no marker).

Conclusions.
—Despite a low overall HCV prevalence in blood donors in the United States, there is marked variation in HCV seroprevalence by demographic subgroup, even after controlling for prior blood transfusion, a recognized risk factor for HCV. Further study of the prevalence of other parenteral risk factors such as past injection drug use among blood donors is needed.

(JAMA. 1996;275:995-1000)

Author Affiliations
Holland Laboratory; UCLA Medical Center; Blood Bank of San Bernadino and Riverside Counties; (Hoxworth Blood Center).

From the University of California, San Francisco (Dr Murphy); Highland General Hospital, Oakland, Calif (Mr Bryzman); American Red Cross Jerome H. Holland Laboratory, Rockville, Md (Dr Williams); Westat Inc, Rockville, Md (Dr Schreiber, Mr Co-Chien, and Mss Matijas and Thomson); American Red Cross Blood Services, Detroit, Mich (Dr Ownby); Oklahoma Blood Institute, Oklahoma City (Dr Gilcher); UCLA Blood and Platelet Center, Los Angeles, Calif (Dr Kleinman); and the National Heart, Lung, and Blood Institute, Bethesda, Md (Dr Nemo).

Footnotes
A complete list of the Retrovirus Epidemiology Donor Study (REDS) Investigators appears at the end of this article.

Reprints: Edward L. Murphy, MD, MPH, Department of Laboratory Medicine, University of California, San Francisco, Box 0884, San Francisco, CA 94143-0884.

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