Concurrent Alcohol Use and Smoking Among US Adults with Hepatitis C

OBJECTIVE: Concurrent alcohol use and smoking exert super-additive toxic effects that accelerate hepatic injury in people living with hepatitis C (HCV). Objectives of this study were to estimate the prevalence of concurrent alcohol use and active smoking at the population-level over the last decade among adults living with HCV in the United States (U.S.), examine trends in the prevalence of concurrent alcohol use and active smoking, and to identify risk factors associated with concurrent alcohol use and active smoking. METHODS: We conducted a repeated cross-sectional analysis using six NHANES cycles (2007-2018). The study population included adults aged ≥20 years with current HCV infection, defined as detectable HCV RNA with confirmatory anti-HCV seropositivity, and complete data on alcohol use and smoking status. Analyses incorporated NHANES' complex survey design (strata, primary sampling units, and MEC examination weights). Prevalence estimates and temporal trends were derived using design-based methods, with linear regression applied to test for trends. Associations were examined using design-adjusted multinomial logistic regression to calculate adjusted odds ratios (aORs). RESULTS: The pooled, survey-weighted prevalence of concurrent alcohol use and active smoking among adults living with HCV in the U.S. between 2007 and 2018 was 39.5%. Trends in the prevalence of concurrent alcohol use and active smoking did not decrease but instead remained relatively high over the 11-year period (Trend P = 0.71). In multivariate analysis, current marijuana use (aOR = 2.88, 95% CI 2.84-2.92), lifetime substance use (aOR = 5.98, 95% CI 5.87-6.10), depression (aOR = 2.59, 95% CI 2.55-2.63), and a history of cancer (aOR = 1.50, 95% CI 1.45-1.54) were positively associated with concurrent alcohol use and active smoking. CONCLUSIONS: Markedly high and non-decreasing rates of concurrent alcohol use and active smoking at the population-level may contribute to higher incident cases of HCV-related morbidity and mortality in the near future.