HCV disease burden greatest among baby boomer veterans

Backus LI. JAMA Intern Med. 2013;doi:10.1001/jamainternmed.2013.8133.

  • July 15, 2013

Veterans born between 1945 and 1965 have a much greater prevalence of anti-HCV and HCV infection compared with other birth cohorts, according to recent results.

In a retrospective cohort study, researchers evaluated data from 5,415,084 veterans who made one or more outpatient visits to VA clinics during 2011, including 2,889,385 who underwent hepatitis C screening. Screening was performed in 40.6% of those born before 1945, 63.5% of those born between 1945 and 1965 and 57% of those born after 1965.

Overall, 6.2% of the cohort had HCV, with variance according to age: 1.7% of those born before 1945 and 1.1% of those born after 1965 had HCV infection, compared with 10.3% of those born between 1945 and 1965. Investigators noted that infection prevalence peaked during 1954, occurring among 18.4% of patients born that year.

HCV was more common among men than women (6.5% vs. 2.8%). Comparisons across races/ethnic groups indicated the highest HCV prevalence among blacks (12.3%), Hispanics (6.7%) and American Indians/Alaskan natives (6.6%). Patients born between 1945 and 1965 had the greatest HCV prevalence across both sexes and all evaluated races/ethnic groups, with the highest rates among men observed in blacks (18.2%) and the lowest among Asians (3.5%).

Anti-HCV was observed in 8.4% of the cohort, and varied similarly by birth cohort, sex and race/ethnicity as HCV infection. Participants born between 1945 and 1965 had the highest anti-HCV prevalence (13.5% vs. 2.9% before 1945 and 1.8% after 1965).

“This high HCV infection prevalence in the 1945-1965 birth cohort substantiates the disproportionate disease burden that underpins the CDC recommendation for birth cohort screening and supports the birth cohort emphasis,” the researchers wrote. “The observed high HCV infection prevalence — relative to prior VA estimates and general population estimates — serves as a reminder of the greater HCV disease burden in the veteran population.

“Full adoption of birth cohort screening may reveal substantial numbers of veterans with previously unknown HCV infection.”