Tattooing and risk of hepatitis B: a systematic review and meta-analysis.

OBJECTIVE The objective of this systematic review and meta-analysis is to assess the association between tattooing and the risk of transmission of hepatitis B virus. METHODS A systematic search of MEDLINE, EMBASE, PubMed, Database of Abstracts of Reviews of Effects, ACP Journal Club and BIOSIS Previews was performed up to March 2011. RESULTS Forty-two observational studies were included in this systematic review, of which 31 were included in the meta-analysis. Pooled odds ratios (95% confidence intervals) of the association of tattooing and hepatitis B infection was 1.48 (1.30-1.68) when all studies were included in the analysis. Subgroup analysis shows the strongest association between tattooing and risk of hepatitis B among populations involved in high-risk behaviours (OR = 1.64, 95% CI: 1.32-2.03). CONCLUSION Findings of the current systematic review and meta-analysis indicate that tattooing is associated with hepatitis B transmission in all subgroups. A population health approach that emphasizes universal hepatitis B immunization, education of young adults who are more likely to get tattoos, and education of prison inmates (who have the highest background rate of hepatitis B infection), along with enforcement of guidelines and safer tattooing practices in prison, are fundamental in prevention of transmission of hepatitis B.