Q&A: First U.S. state-by-state analysis of hepatitis C cases
By Jon Cohen
Apr. 26, 2017 , 12:00 PM
In the infectious disease world, the liver-damaging hepatitis C virus (HCV) long has lived in the shadows of killers such as HIV/AIDS, tuberculosis, and malaria. But curative—and expensive—HCV drugs that have come to market over the past 5 years have focused new attention on the deadly disease.
Now, for the first time, researchers have mapped its U.S. prevalence state-by-state. They hope their model ultimately will help improve targeting of efforts to screen for the virus and treat the more than 3 million people in the country who are living with the infection.
Eli S. Rosenberg Eric W. Hall Patrick S. Sullivan Travis H. Sanchez Kimberly A. Workowski John W. Ward Deborah HoltzmanClin Infect Dis cix202.
Published: 26 April 2017
Background.Hepatitis C virus (HCV) infection is the most common chronic blood-borne infection in the United States and a leading cause of morbidity and mortality. Previous analyses of the US National Health and Nutrition Examination Survey (NHANES) indicated approximately 3.6 million noninstitutionalized persons with antibody to HCV (anti-HCV). However, state-level prevalence remains less understood and cannot be estimated reliably from NHANES alone.
Methods.We used 3 publicly available government data sources to estimate anti-HCV prevalence in each US state among noninstitutionalized persons aged ≥18 years. A small-area estimation model combined indirect standardization of NHANES-based prevalence with logistic regression modeling of mortality data, listing acute or chronic HCV infection as a cause of death, from the National Vital Statistics System during 1999–2012. Model results were combined with US Census population sizes to estimate total number and prevalence of persons with antibody to HCV in 2010.
Results.National anti-HCV prevalence was 1.67% (95% confidence interval [CI], 1.53–1.90), or 3 911 800 (95% CI, 3 589 400– 4 447 500) adults in 2010. State-specific prevalence ranged from 0.71% (Illinois) to 3.34% (Oklahoma). The West census region had the highest region-specific prevalence (2.14% [95% CI, 1.96–2.48]); 10 of 13 states had rates above the national average. The South had the highest number of persons with anti-HCV (n = 1561600 [95% CI, 1 427 700–1 768 900]). The Midwest had the lowest region-specific prevalence (1.14% [95% CI, 1.04%–1.30%]).
Conclusions.States in the US West and South have been most impacted by hepatitis C. Estimates of HCV infection burden are essential to guide policy and programs to optimally prevent, detect, and cure infection.
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