Role of hepatitis A virus in diabetes mellitus

Table 1 Study population clinical characteristics, n (%)

n		19942
Gender	Female	10256 (51.43)
Age	Year	49 ± 18
Body mass index	Kg/m2	28.94 ± 6.75
Fasting plasma glucose1	mmol/L	6.1 ± 2.1
2-h plasma glucose2	mmol//L	6.8 ± 2.9
HbA1c3	%	5.7 ± 1.0
HbA1c3	mmol/mol	38.90 ± 11.45
Current smoker	Yes	4651 (23.32)
Current alcohol consumption	Yes	13069 (65.54)
Education: at least high school graduate	Yes	14467 (72.55)
Poverty index		2.72 ± 1.70
Family history of diabetes	Yes	7936 (39.80)
States of glucose tolerance
Diabetes	Yes	3463 (17.37)
Established diabetes	Yes	2430 (12.19)
Undiagnosed diabetes	Yes	1033 (5.18)
Hepatitis A vaccination	Yes	4229 (21.21)
Presence of anti-HAV antibody	Yes	9224 (46.25)
Ethnic/racial groups
Mexican American		3307 (16.58)
Other Hispanic		1787 (8.96)
Non-Hispanic white		9205 (46.16)
Non-Hispanic black		4131 (20.72)
Other		1512 (7.58)

¹n = 7105.

²n = 7125.

³n = 19910.

Mean ± STD or n percent.

HAV: Hepatitis A virus.

Table 2 Distribution of hepatitis A antibody and vaccination history, n (%)

	No for HAV vaccination	Yes for HAV vaccination	Subtotal1
Anti-HAV antibody presence	6945 (44.20)	2279 (53.89)	9224 (46.25)
Anti-HAV antibody absence	8768 (55.80)	1950 (46.11)	10718 (53.75)
Subtotal1	15713 (78.79)	4229 (21.21)	19942 (100.00)

¹n (raw percent).

Pearson Chi-Square = 125.876927, degree of freedom = 1, P < 0.0001. n (column percent). HAV: Hepatitis A virus.

Table 3 Comparison of clinic characteristics of subjects with and without hepatitis A virus infection, n (%)

		Non-infected			Infected			P
n		12997			6945
Gender	Female	6738 (51.84)			3518 (50.66)			NS
Age	Yr	46 ± 17			56 ± 18			< 0.0001
Body mass index	Kg/m2	29.00 ± 7.01			28.82 ± 6.24			NS
Fasting plasma glucose1	mmol/L	5.8 ± 1.8			6.4 ± 2.4			< 0.0001
2-h postchallenged plasma glucose2	mmol/L	6.4 ± 2.7			7.4 ± 3.4			< 0.0001
HbA1c3	%	5.6 ± 0.9			5.9 ± 1.2			< 0.0001
HbA1c3	mmol/mol	37.66 ± 10.20			41.22 ± 13.18			< 0.0001
Current smoker	Yes	3418 (26.30)			1233 (17.75)			< 0.0001
Current alcohol consumption	Yes	9089 (69.93)			3980 (57.31)			< 0.0001
Education: at least high school graduate	Yes	10668 (82.08)			3799 (54.70)			< 0.0001
Poverty index		2.87 ± 1.70			2.44 ± 1.66			< 0.0001
Family history of diabetes	Yes	5074 (39.04)			2862 (41.21)			0.003
Established diabetes	Yes	1217 (9.36)			1213 (17.47)			< 0.0001
States of glucose tolerance								< 0.0001
Normal glucose tolerance		7512 (57.80)			2799 (40.30)
Impaired glucose tolerance		3734 (28.73)			2434 (35.05)
Diabetes		1751 (13.47)			1712 (24.65)
Hepatitis A vaccination	Yes	4229 (32.54)			0 (0.00)			< 0.0001
Presence of hepatitis A antibody	Yes	2279 (17.53)			6945 (100.00)			< 0.0001
Ethnic/racial								< 0.0001
Mexican American		1184 (9.11)			2123 (30.57)
Other Hispanic		800 (6.16)			987 (14.21)
Non-Hispanic white		7346 (56.52)			1859 (26.77)
Non-Hispanic black		2807 (21.60)			1,324 (19.06)
Other		860 (6.62)			652 (9.39)

Mean ± STD.

¹For non-infected: n = 4579; For infected: n = 2526.

²For non-infected: n = 4777; For infected: n = 2438.

³For non-infected: n = 12978; For infected: n = 6932.

Table 4 Odds ratio and 95% confidence intervals for diabetes by hepatitis A virus infection, n (%)

Status	HAV infection	n	Diabetes	Model 1	Model 2	Model 3	Model 4
All diabetes	No	12997	1751 (13.47)	1.45	1.22	1.22	1.13
	Yes	6945	1712 (24.65)	(1.40-1.50)	(1.17-1.27)	(1.17-1.28)	(1.08-1.18)
Established diabetes	No	12997	1217 (9.36)	1.43	1.20	1.21	1.11
	Yes	6945	1213 (17.47)	(1.37-1.49)	(1.14-1.26)	(1.15-1.27)	(1.05-1.16)
Diabetes by fasting plasma glucose criterion	No	4579	432 (9.43)	1.44	1.22	1.21	1.12
	Yes	2526	451 (17.85)	(1.35-1.55)	(1.13-1.32)	(1.12-1.31)	(1.03-1.21)
Diabetes by 2-h postchallenged plasma glucose criterion	No	4777	277 (5.80)	1.46	1.21	1.17	1.11
	Yes	2348	274 (11.67)	(1.34-1.60)	(1.10-1.33)	(1.07-1.29)	(1.01-1.23)
Diabetes by HbA1c criterion	No	12978	1023 (7.88)	1.47	1.27	1.28	1.19
	Yes	6932	1085 (15.65)	(1.41-1.54)	(1.21-1.34)	(1.22-1.35)	(1.12-1.25)

Model 1, unadjusted; Model 2, adjusted for gender, age, and body mass index (BMI); Model 3, adjusted for gender, age, BMI, and ethnic/racial group; Model 4, adjusted for gender, age, BMI, ethnic/race group, active smoker, active alcohol consumption, family history of diabetes, poverty index, and education. HAV: Hepatitis A virus.

Table 5 Odds ratio and 95% confidence intervals for diabetes by hepatitis A virus vaccination, n (%)

Status	HAV vaccination	n	Diabetes	Model 1	Model 2	Model 3	Model 4
All diabetes	No	15713	2920 (18.58)	0.65	1.02	1.03	1.06
	Yes	4229	543 (12.84)	(0.58-0.71)	(0.91-1.14)	(0.92-1.14)	(0.95-1.18)
Established diabetes	No	15713	2039 (12.98)	0.68	1.08	1.08	1.12
	Yes	4229	391 (9.25)	(0.61-0.77)	(0.96-1.22)	(0.96-1.22)	(0.99-1.28)
Diabetes by fasting plasma glucose criterion	No	5578	750 (13.45)	0.61	0.95	0.95	0.97
	Yes	1527	133 (8.71)	(0.51-0.75)	(0.77-1.16)	(0.77-1.17)	(0.78-1.19)
Diabetes by 2-h postchallenged plasma glucose criterion	No	5550	478 (8.61)	0.52	0.85	0.86	0.88
	Yes	1575	73 (4.63)	(0.40-0.66)	(0.65-1.10)	(0.66-1.12)	(0.67-1.15)
Diabetes by HbA1c criterion	No	15690	1772 (11.29)	0.68	1.03	1.03	1.06
	Yes	4220	336 (7.96)	(0.60-0.77)	(0.90-1.17)	(0.90-1.17)	(0.93-1.21)

Model 1, unadjusted; Model 2, adjusted for gender, age, and body mass index (BMI); Model 3, adjusted for gender, age, BMI, and ethnic/racial group; Model 4, adjusted for gender, age, BMI, ethnic/race group, active smoker, active alcohol consumption, family history of diabetes, poverty index, and education. HAV: Hepatitis A virus.

Table 6 Odds ratio and 95% confidence intervals for diabetes by successful hepatitis A virus immunization, n (%)

Status	Successful HAV immunization	n	Diabetes	Model 1	Model 2	Model 3	Model 4
All diabetes	No	17663	3126 (17.70)	0.81	1.10	1.10	1.11
	Yes	2279	337 (14.79)	(0.71-0.91)	(0.96-1.26)	(0.96-1.25)	(0.97-1.27)
Established diabetes	No	17512	2039 (11.64)	0.83	1.13	1.13	1.14
	Yes	2430	240 (9.88)	(0.72-0.96)	(0.97-1.31)	(0.97-1.31)	(0.98-1.33)
Diabetes by fasting plasma glucose criterion	No	6244	796 (12.75)	0.77	1.06	1.05	1.05
	Yes	861	87 (10.10)	(0.61-0.97)	(0.83-1.36)	(0.82-1.35)	(0.82-1.36)
Diabetes by 2-h postchallenged plasma glucose criterion	No	6243	498 (7.98)	0.74	1.02	1.01	1.03
	Yes	882	53 (6.01)	(0.55-0.99)	(0.75-1.39)	(0.74-1.37)	(0.76-1.40)
Diabetes by HbA1c criterion	No	17636	1900 (10.77)	0.83	1.11	1.11	1.12
	Yes	2274	208 (9.15)	(0.72-0.97)	(0.95-1.30)	1.30)	(0.95-1.32)

Model 1, unadjusted; Model 2, adjusted for gender, age, and body mass index (BMI); Model 3, adjusted for gender, age, BMI, and ethnic/racial group; Model 4, adjusted for gender, age, BMI, ethnic/race group, active smoker, active alcohol consumption, family history of diabetes, poverty index, and education. HAV: Hepatitis A virus.

Table 7 Odds ratio and 95% confidence intervals for hepatis A virus infection by diabetes status in non-hepatitis A vaccinated participants, n (%)

Status	Diabetes	n	HAV infection	Model 1	Model 2	Model 3	Model 4
All diabetes	No	12793	5233 (40.91)	2.05	1.59	1.65	1.40
	Yes	2920	1712 (58.63)	(1.89-2.22)	(1.45-1.74)	(1.50-1.81)	(1.27-1.54)
Established diabetes	No	13674	5732 (41.92)	2.03	1.57	1.67	1.39
	Yes	2039	1213 (59.49)	(1.85-2.24)	(1.42-1.73)	(1.50-1.85)	(1.24-1.56)
Diabetes by fasting plasma glucose criterion	No	4828	2075 (42.98)	2	1.56	1.58	1.34
	Yes	750	451 (60.13)	(1.71-2.34)	(1.32-1.85)	(1.32-1.87)	(1.11-1.61)
Diabetes by 2-h postchallenged plasma glucose criterion	No	5072	2074 (40.89)	1.94	1.48	1.39	1.27
	Yes	478	274 (57.32)	(1.61-2.35)	(1.21-1.81)	(1.13-1.71)	(1.02-1.58)
Diabetes by HbA1c criterion	No	13918	5847 (42.01)	2.18	1.76	1.87	1.59
	Yes	1772	1085 (61.23)	(1.97-2.41)	(1.58-1.96)	(1.67-2.09)	(1.42-1.80)

Model 1, unadjusted; Model 2, adjusted for gender, age, and body mass index (BMI); Model 3, adjusted for gender, age, BMI, and ethnic/racial group; Model 4, adjusted for gender, age, BMI, ethnic/race group, active smoker, active alcohol consumption, family history of diabetes, poverty index, and education. HAV: Hepatitis A virus.