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Tattoos Increase Risk of Hepatitis C
By Michael Smith, North American Correspondent, MedPage Today
Published: August 09, 2010
Reviewed by Adam J. Carinci, MD; Instructor, Harvard Medical School and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
The global fad for tatoos, particularly among young people, is growing -- and along with it the risk of acquiring hepatitis C, according to a multinational study.
A systematic review and meta-analysis of 124 published studies from 30 countries, found that people with tattoos were almost three times more likely to have hepatitis C as those without tattoos, according to Jane Buxton, MD, of the British Columbia Centre for Disease Control in Vancouver, and colleagues.
But in some subgroups -- particularly non-injection drug users -- the odds of having the virus were almost six-fold higher, Buxton and colleagues wrote online in the International Journal of Infectious Diseases.
In recent years, tattoos have become increasingly popular. An estimated 36% of Americans under 30 have the skin designs, the researchers wrote. In Canada, they added, around 8% of high school students have at least one tattoo and among those without a tattoo, 21% are eager to get one. Since tattoo instruments come in contact with blood and bodily fluids, infection is possible if instruments are used on more than one person without being sterilized or without proper hygiene, the researchers noted. Additionally, tattoo dyes are not kept in sterile containers and may also transmit infections, they wrote.
To help quantify the risks, the researchers reviewed and analyzed 124 studies from 30 countries -- including Canada, Iran, Italy, Brazil and the U.S. Of those, 83 cross-sectional, case-control, and cohort studies were included in the meta-analysis.
The pooled odds ratio for hepatitis C -- comparing those with and without tattoos -- was 2.74 (95% CI 2.38 to 3.15), they found.
However, in sub-group analyses, the risk could go much higher, they found. For example, in samples derived from non-injection drug users the OR was 5.74 (95% CI 1.98 to 16.66).
In other groups, the odds ratios were:
Some studies had wide confidence intervals, the researchers reported, but when those were discounted there was little change in the overall effect size.
One limitation of the analysis is the observational nature of the included studies, the researchers wrote. As well, they added, studies with a non-significant effect may not have been published, which would tend to increase the observed odds ratios.
What's needed, the researchers concluded, are infection-control guidelines for tattoo artists and clients, and enforcement through inspections, reporting of adverse events and record keeping. Also, they wrote, prevention programs should focus on young people -- those most likely to get tattoos -- and among prison inmates -- who live in environments with a higher prevalence of hepatitis C.
A systematic review and meta-analysis of 124 published studies from 30 countries, found that people with tattoos were almost three times more likely to have hepatitis C as those without tattoos, according to Jane Buxton, MD, of the British Columbia Centre for Disease Control in Vancouver, and colleagues.
But in some subgroups -- particularly non-injection drug users -- the odds of having the virus were almost six-fold higher, Buxton and colleagues wrote online in the International Journal of Infectious Diseases.
Action Points
- Discuss with patients that tattooing is associated with a higher risk of hepatitis C infection.
- Point out that one limitation of this analysis is the observational nature of the included studies -- and that such studies can neither prove nor disprove causality.
In recent years, tattoos have become increasingly popular. An estimated 36% of Americans under 30 have the skin designs, the researchers wrote. In Canada, they added, around 8% of high school students have at least one tattoo and among those without a tattoo, 21% are eager to get one. Since tattoo instruments come in contact with blood and bodily fluids, infection is possible if instruments are used on more than one person without being sterilized or without proper hygiene, the researchers noted. Additionally, tattoo dyes are not kept in sterile containers and may also transmit infections, they wrote.
To help quantify the risks, the researchers reviewed and analyzed 124 studies from 30 countries -- including Canada, Iran, Italy, Brazil and the U.S. Of those, 83 cross-sectional, case-control, and cohort studies were included in the meta-analysis.
The pooled odds ratio for hepatitis C -- comparing those with and without tattoos -- was 2.74 (95% CI 2.38 to 3.15), they found.
However, in sub-group analyses, the risk could go much higher, they found. For example, in samples derived from non-injection drug users the OR was 5.74 (95% CI 1.98 to 16.66).
In other groups, the odds ratios were:
- 3.73, for blood donors (95% CI 2.46 to 5.67).
- 3.20, for samples from hospitals (95% CI 2.25 to 4.56).
- 3.06, for injection drug users (95% CI 1.2 to 7.25).
- 2.80, in high-risk populations, (95% CI 1.63 to 4.82).
- 2.79, in community samples (95% CI 1.95 to 4.00).
- 2.56, in prison samples (95% CI 1.97 to 3.32).
Some studies had wide confidence intervals, the researchers reported, but when those were discounted there was little change in the overall effect size.
One limitation of the analysis is the observational nature of the included studies, the researchers wrote. As well, they added, studies with a non-significant effect may not have been published, which would tend to increase the observed odds ratios.
What's needed, the researchers concluded, are infection-control guidelines for tattoo artists and clients, and enforcement through inspections, reporting of adverse events and record keeping. Also, they wrote, prevention programs should focus on young people -- those most likely to get tattoos -- and among prison inmates -- who live in environments with a higher prevalence of hepatitis C.
There was no external support for the study.
The authors said they had no conflict of interest in the tattoo industry.
The authors said they had no conflict of interest in the tattoo industry.
Primary source: International Journal of Infectious Diseases
Source reference:
Jafari S et al. "Tattooing and the risk of transmission of hepatitis C: a systematic review and meta-analysis" Int J Infect Dis 2010; DOI: 10.1016/j.ijid.2010.03.019.
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