Tattoo practices and risk of hepatitis B and hepatitis C infection in the French Constances study

Reassessing the impact of tattooing circumstances on hepatitis B (HBV) and hepatitis C (HCV) virus transmission to inform the World Health Organization's hepatitis strategy, which aims to reduce transmission by 90% by 2030.

Using data from the Cancer Risk Associated with the Body Art of Tattooing (CRABAT) study embedded in the French cohort Constances, we examined the associations of tattooing circumstances with history of HBV and/or HCV infections (self-reported and/or hospital records). Cross-sectional multivariate logistic regression models were fitted in the population aged 45 years and older, as well as retrospective cohort analyses restricted to a subsample of participants with confirmed first tattoo and infection date, all adjusted for known hepatitis risk factors.

Of 77,826 questionnaire respondents, 7.4% (n = 5766) were tattooed, and 3330 (4.9%) answered a complementary tattoo exposure questionnaire in 2023. Tattooing was associated with an increased prevalence of any hepatitis in the multivariate (prevalence odds ratio: 1.49 [95% confidence interval: 1.16-1.91]) and Cox models (hazard ratio [HR]: 1.6 [1.22-2.08]). The strongest risks were found for HCV with tattooing outside studios (HR: 4.14 [2.33-7.35]) and for HBV with tattooing outside countries with regulations (HR: 3.22 [1.39-7.44]).

Unsafe tattooing practices as preventable risk factor for hepatitis transmissions could be underestimated.