The relationship between hepatitis A and hepatitis b susceptibility and social determinants in 2014 in Manisa

INTRODUCTION AND OBJECTIVE Hepatitis B virus causes a number of liver diseases ranging from acute, chronic, fulminant hepatitis, cirrhosis and hepatocellular carcinoma. Approximately 240 million people worldwide are infected with chronic hepatitis B. According to the World Health Organization, our country is among low-mid level endemic (HBsAg 2-7%) regions. Hepatitis B in our country was taken to the routine vaccination program in 1998. Hepatitis A is a worldwide, sporadic and epidemic viral disease. It is estimated that in 2005, 119 million people were infected with hepatitis A, 31 million people were symptomatically ill, and 34 thousand people died. The rate of hepatitis A mortality is 0.1% for those younger than 15 years old and 2.1% for those older than 40 years. With the advancing age, the risk of complications such as fulminant hepatitis, cholestatic hepatitis increases. Our country is the medium endemic region. In our country, hepatitis A was taken into routine vaccination program in 2012. In this study, it was aimed to examine the susceptibility of Hepatitis A and B and the relation with social determinants in 2014 in Manisa. METHOD The research was carried out through the data of 'Determining the Seroprevalence of Some Preventable Diseases in Manisa, 2013'. The population of the study is composed of all individuals over the age of two (N = 1.317.917) registered in the Manisa Family Medicine Information System in October 2013. Assuming the lowest expected seronegativity of 2.0% and the absolute error margin of 0.75%, at the 95% confidence level the calculated sample size is at least 1337. The sample size was set at 1740 by adding 30% spare to this number. The sample was selected by simple random method from Manisa Family Medicine Information System records. The data was collected in the family health centers between the date of 18.03.2014 and 22.06.2014. The study was conducted with Roche-Cobas e 411 (Roche Diagnostics GmbH, Mannheim, Germany) device using the electrochemiluminescence immunoassay method with HBsAg positivity, Anti-HBs positivity and Anti-HBc positivity and the compatible kits. The device and kits were used in the guidance of the directives of the manufacturer. Dependent variables in the study were susceptibility to hepatitis A and susceptibility to hepatitis B; independent variables are sex, age, educational status, occupational class, place of settlement, childhood settlement, perceived income level, monthly income level, household density, toilet position and vaccination status. The relationship between independent variables and dependent variables was examined by chi-square and Fisher's exact test. The crude and corrected for each age variable Odds ratios and 95% confidence intervals were calculated by logistic regression method. RESULTS The susceptibility rate of Hepatitis A in the study was 24.4%. When the susceptibility to hepatitis A is compared to the social determinants, there was a significant relationship between Hepatitis A susceptibility and childhood settlement, education status, occupational status, perceived income and the position of the toilet. This relationship was disappeared when it was corrected according to age. There was a significant relationship between Hepatitis A susceptibility and household density and when adjusted for age, this relationship continued in the opposite direction. There was no significant relationship between susceptibility to Hepatitis A and gender, place of settlement and per capita equivalent income (p> 0.05). In this study, susceptibility to Hepatitis B was 50.8%, vaccination against hepatitis B was 28%, improvement in Hepatitis B infection was 15.0%, HBsAg carriage 1.5% and isolated Anti-HBc positivity was 4.7%. When the relationship with social determinants and the people who are susceptible to Hepatitis B were examined, there was a significant correlation between the susceptibility of Hepatitis B and age groups over 19 years of age. When the age was corrected, this relationship was maintained between 20-59 years of age (p <0.001). There was a significant relationship between the Hepatitis B susceptibility and education status, per capita equivalent income, and household density and this relationship remained unchanged when adjusted for age. There was a significant correlation between Hepatitis B and occupational status and the relationship maintained when adjusted for age (p <0.001). There was no significant relationship between Hepatitis B susceptibility and gender, place of settlement, childhood settlement and perceived income level (p> 0.05). DISCUSSION The susceptibility rate of Hepatitis A is 24.4% and higher in the child age group. Since the susceptibility rate is higher in the child age group, vaccination and health education service planning should be done. The susceptibility rate to hepatitis B is 50.8% and young adults constitute the most risky group. Susceptibility to hepatitis B is high in some occupational groups (self employed, employers, unemployed, skilled occupations, agricultural workers, production workers, out of work, irregular incomes). Young adult age group and occupational status should be considered when determining the need for health care for hepatitis B control. Key words: Hepatit A, Hepatit B, susceptibility, social determinants