Abstract: 【Abstract】 Objective To investigate the epidemiological characteristics of Kaposi sarcoma-associated herpesvirus （KSHV） infection and its associated socio-behavioral factors. Methods A cross-sectional study was conducted. Using a stratified cluster random sampling method, participants were collected from 8 prefectures in the Xinjiang Uygur Autonomous Region between January and September 2023. Data on patients' demographic characteristics and social behaviors, including sex, age, ethnicity, occupation, marital status, smoking history, alcohol use, education levels, dietary habits, and body mass index （BMI）, were collected via a standardized questionnaire. Venous blood samples were obtained for KSHV antibody testing. Based on the test results, participants were divided into a KSHV-negative group and a KSHV-positive group. Statistical analyses included the chi-square test, univariate and multivariate logistic regression models, and subgroup analyses. Results A total of 1 794 participants were included, comprising 905 males （50.45%） and 889 females （49.55%）, aged 18 - 89 （51.87 ± 13.85） years. Participants were from 8 prefectures, including Hotan, Kashgar, Korla, and Artux in southern Xinjiang, as well as Yining, Tacheng, Turpan, and Changji in northern Xinjiang, and from 5 ethnic groups, including Uygur （914 cases）, Kazakh （401 cases）, Hui （216 cases）, Kyrgyz （157 cases）, and Han （86 cases）. Among the 1 794 participants, 314 （17.50%） were seropositive for KSHV; seropositivity rates varied significantly across regions （range: 7.1% - 29.05%）, with the highest rate in Korla （P < 0.05）; significant differences in seropositivity rates were also observed among ethnic groups （P < 0.05）, with higher rates in the Han （27.91%） and Hui （26.39%） ethnic groups, and lower rates in the Kyrgyz （23.36%）, Uygur （15.21%）, and Kazakh （13.22%） ethnic groups. KSHV seropositivity rates also varied significantly across ethnicity, age, occupation （farmer/herder vs. others）, smoking history （with vs. without）, alcohol use history （with vs. without）, and BMI （all P < 0.05）. Multivariate analysis identified farming/herding occupation （OR = 1.393, 95% CI: 1.077 - 1.803, P = 0.012）, alcohol use （OR = 1.466, 95% CI: 1.031 - 2.083, P = 0.033）, and low BMI （OR = 0.951, 95% CI: 0.925 - 0.978, P < 0.001） as factors associated with elevated KSHV infection risk. In subgroup analyses, increased BMI was associated with reduced KSHV infection risk among the Han （OR = 0.867, 95% CI: 0.764 - 0.983, P = 0.026） and Uygur （OR = 0.931, 95% CI: 0.893 - 0.971, P < 0.001） ethnic groups, as well as across all sex, age, and regional subgroups （all P < 0.05）. Among Kazakh, male, and northern Xinjiang populations, engagement in farming/herding and having a history of alcohol use were associated with a higher KSHV infection risk （all P < 0.05）; among individuals aged < 50 years, engagement in farming/herding was associated with a higher KSHV infection risk （all P < 0.05）. Conclusions KSHV infection rates exhibited significant geographic and demographic variations. Low BMI, farming/herding occupation, and alcohol use were independent risk factors for KSHV infection.

Key words: Kaposi sarcoma-associated herpesvirus, Serologic tests, Epidemiology, Body mass index, Social behavior