CULTURAL FACTORS RELATED TO THE EPIDEMIOLOGY OF VIRAL HEPATITIS IN A SOUTHWESTERN UNITED STATES COUNTY (INFECTIOUS DISEASE, SOCIOECONOMIC, PUBLIC HEALTH, BEHAVIOR, COMMUNICABLE).

Abstract

Viral hepatitis has been a universal human affliction for thousands of years. Only recently has it become understood, and there are still many unanswered questions. This dissertation examines the epidemiology of viral hepatitis in a county in the southwestern United States. An historical review traces the history of concepts of jaundice and details recent advances in the understanding of the transmission of the clinical entities grouped under the heading of viral hepatitis. Age specific incidence rates for all forms of hepatitis in the study population are compared to national rates. Data indicate that the study population experiences higher rates of enteric disease and lower rates of sexually transmitted disease than the nation as a whole. The hypothesis that diseases with similar routes of transmission will be associated with each other and show similar socioeconomic patterns was tested using three year average census tract incidence rates for 1982-84. In almost all samples, hepatitis A and shigellosis are more similar to each other than either is to hepatitis B. A similarity between hepatitis B and syphilis is also evident, but in fewer samples, reflecting their more disparate routes of transmission. Different relationships between incidence rates and socioeconomic variables are evident when the analysis is done using data from the fifty states for 1982. Participant observation as a disease investigator generated information on beliefs about hepatitis among lay and medical personnel. Often these beliefs diverge significantly from accepted facts about hepatitis. These findings have implications for the design of public health programs to control communicable diseases with similar modes of transmission.