University at Albany School of Public Health faculty member Dr. Eli Rosenberg, staff researcher Ms. Elizabeth Rosenthal, and MPH student Ms. Meredith Barranco, along with a team from the Centers for Disease Control and Prevention (CDC) and Emory University, recently released “Prevalence of hepatitis C virus (HCV) infection among adults in each U.S. state from 2013-2016“; the study was published in JAMA Network Open and found higher prevalence of HCV in the West and Appalachian states in comparison to other areas. This work provides crucial insight for the HCV epidemic, as our state-level picture of HCV burden remains incomplete from current national surveillance.
HCV is a bloodborne infection spread through exposure to infected bodily fluids, typically blood. It is a leading cause of liver-related morbidity and mortality in the U.S., with approximately 18,000 deaths due to HCV in 2016 alone. New HCV infections are on the rise in the U.S. – a trend related to the opioid epidemic, as sharing needles increases exposure to others’ bodily fluids. However, the possibility of eliminating HCV has been widely discussed in the public health community.
“HCV is a complex epidemic, but it is one that faces significant momentum towards elimination now that direct-acting antivirals have made it curable,” says Dr. Rosenberg. “Obtaining infection estimates by state and providing an in-depth look at the distribution of infection enables states and organizations to better allocate resources – and implement policies and programs – particularly as some jurisdictions weigh elimination strategies.”
To find the state-level prevalence estimates of HCV, the researchers examined National Health and Nutritional Examination Survey (NHANES) data on HCV infection from 1999-2016 by sex, race/ethnicity, birth cohort, and poverty. Next, using all death certificates in the National Vital Statistic System during this time period, these national numbers were adjusted by state-level rates of HCV-related and narcotic-overdose death-related mortality, relative to the U.S. average, in order to yield local patterns of HCV infection. To capture populations not included in NHANES data (such as those who are incarcerated, experiencing unsheltered homelessness, and residing in nursing homes), the team estimated further infections by applying literature-based estimates of prevalence.
The research team estimated that there were 2.3 million persons in the U.S. with current HCV infection from 2013-2016. There was significant variation in the number of infections by state, ranging from 0.45 percent to 2.34 percent of the total state population, with a median of 0.88 percent. Of the 13 states that fall into the West census region, 10 states were above the median rate and the region was home to 27.1 percent of all infected persons. Nine states (California, Texas, Florida, New York, Pennsylvania, Ohio, Michigan, Tennessee, and North Carolina) contained over half of all persons living with HCV infection (51.9 percent), and of these states, 5 were located in Appalachia. Three of the 10 states with the highest prevalence of infections were also located in Appalachia. A full listing of estimated total and prevalence of persons with current HCV by state can be found in the publication.
These estimates show that the HCV epidemic is not uniform across states, and therefore, closer examination of various populations must take place to determine the most effective ways to reduce and eliminate HCV by state. Some state patterns of high burden may be linked to increased injection drug use, further complicating the issue.
For interactive maps of these Hepatitis C results by state, as well as a host of related hepatitis and opioid-related indicators, visit hepvu.org.