Data obtained from five continuous cycles of the National Health and Nutrition Examination Survey (NHANES), conducted between 1999 and 2008, were combined into two larger periods: 1999-2004 and 2005-2008. The NHANES is a nationwide survey representing the health and nutritional status of the of the noninstitutionalized civilian U.S. population. Ruxolitinib These data were collected by the U.S. National

Center for Health Statistics (NCHS) of the CDC via household interviews, physical examinations, and laboratory data, including blood and urine samples collected in designated examination centers. The surveys included similar questionnaires and methods for serum and blood assays. Demographic, clinical, and laboratory parameters were transformed, according to the provided guidelines, to

make the data comparable between the cycles.37 The distribution of participants was representative of the U.S. population after weighting on the basis of age, gender, level of education, and race or ethnic background.37 Inclusion criteria were the following: age of 18 years or older and availability of complete demographic, social history, clinical data, socioeconomic status, medical conditions, and vaccination questionnaires. Body mass index (BMI), waist circumference, and blood pressure were measured for all NHANES participants at time of examination. Additional laboratory tests included the following: fasting serum glucose and insulin, triglycerides, Palbociclib high-density lipoprotein (HDL), low-density lipoprotein (LDL) and total cholesterol, aspartate aminotransferase (AST), alanine transaminase (ALT), and transferrin saturation. Hepatitis A total immunoglobulin G (IgG) antibody (anti-HAV), hepatitis B core antibody (anti-HBc), hepatitis B surface antibody (anti-HBs), and hepatitis C antibody (anti-HCV) were determined with the enzyme-linked immunosorbent assay (ELISA), and hepatitis B surface Methane monooxygenase antigen (HBsAg) was tested in duplicate using AUSZYME Monoclonal test (Abbott Diagnostics, Abbott Park, IL). HCV RNA was determined by polymerase chain reaction (PCR). Participants with data insufficient for ruling in or ruling out CLD, diabetes, or without vaccination

questionnaires were excluded. Excluded participants were not different from included participants in any other way. Medical definitions used throughout the study are summarized in Table 1. Comorbidities that could be associated with the prevalence and effectiveness of HepA and HepB vaccination were assessed using the Medical Conditions questionnaires completed by NHANES participants. Human immunodeficiency virus (HIV) positivity was determined with the ELISA anti-HIV test (run for individuals of age under 50 years). The health insurance status of the participants was determined using the NHANES Health Insurance Questionnaire. A modified insurance questionnaire was used in the 2005-2008 study cycle; so, the data were transformed as recommended.