Approximately 4.1 million Americans are infected with HCV; HCV has infected four times as many people as HIV. It is most prevalent in the younger population (ages 30-49) and 70% are chronically infected. The majority of HCV infection can be traced to individuals' behaviors; intravenous drug use accounts for most infections. Tattoos, body piercing, blood transfusions prior to 1992, and exposure to contaminated blood among health care workers are other routes. HCV is responsible for approximately 8,000 to 10,000 deaths per year; this number is expected to triple in the next 10 to 20 years without effective intervention and prevention. HCV is the most common indication for liver transplant and no preventative vaccination has been developed. HCV is largely asymptomatic and research has focused on medical transmission, prevention, and treatment. Research on the social implications is lacking.
Theoretical perspectives of Parsons' sick role, Goffman's stigma, Strauss and Glaser's work on chronic illness, and Bury's biographical disruption will be addressed. This study aims to advance our understanding of the measurement of HRQL among patients with HCV, to develop and test a conceptual model explaining HRQL, and to compare the parameter estimates and explained variation for models predicting HRQL.
Cross-sectional analyses of data (N=269) from two clinical pharmaceutical trials involving patients with HCV who presented for treatment is utilized. Data is unique in that it includes two measures of HRQL, a generic measure (SF-36) and a disease-specific measure (CLDQ-HCV) as well as socio-demographic (age, gender, race, marital status, body mass index, social (stigma via route of transmission), and clinical (cirrhosis, HCV-RNA virus level, HCV genotype, treatment status) variables. Confirmatory factor analysis and ordinary least squares regression are utilized.
Both the SF-36 and CLDQ-HCV yielded more parsimonious structures. OLS regression found body mass index (BMI) and cirrhosis to be the most significant predictors across all models. Age, other race, married, and a not stigmatized route of transmission were found to be significant in a few of the models. This dissertation expands our knowledge of the HRQL of those with HCV and can be used to help these patients in a treatment setting.