A state-level evaluation of the burden of hepatitis C virus infection revealed that states in the Western and Southern United States are most impacted by the disease.
“State-level estimates of the prevalence of HCV infection are essential for guiding intervention programs, research and federal assistance funding priorities among U.S. states,” Eli S. Rosenberg, PhD, from the department of epidemiology at Emory’s Rollins School of Public Health, and colleagues wrote. “Current U.S. surveillance programs provide incomplete estimates of HCV infection prevalence … there is no complete set of state-specific estimates of HCV infection prevalence for all U.S. states that is based on accurate and consistent methods.”
Researchers used three government data sources, including the U.S. National Health and Nutrition Examination Survey, or NHANES, to estimate the prevalence of HCV antibody (anti-HCV) in each U.S. state among noninstitutionalized individuals aged 18 years and older. They combined indirect standardization of NHANES–based prevalence with logistic regression modeling of mortality data, with acute or chronic HCV infection listed as a cause of death, from the National Vital Statistics System during 1999-2012 to create a small-area estimation model. To assess the total number and prevalence of those with anti-HCV in 2010, model results were combined with U.S. Census population sizes.
In 2010, the national anti-HCV prevalence was 1.67% (95% CI, 1.53-1.9) — or almost 4 million U.S. adults with HCV. State-specific prevalence of anti-HCV ranged from 0.71% in Illinois to 3.34% in Oklahoma. The results showed that the highest prevalence of HCV infection was in the West (2.14%; 95% CI, 1.96-2.48), with 10 of 13 states experiencing rates above the national average. Estimates revealed that more than 1.5 million individuals in the South had anti-HCV. The region with the lowest prevalence was the Midwest (1.14%; 95% CI, 1.04-1.3).
“Although national recommendations for HCV prevention, testing and clinical management are developed by the CDC and other authorities, decisions regarding the capacity to deliver these services are made at the state level,” Rosenberg and colleagues wrote. “Having state-level estimates calculated consistently across states will allow states to assess their standing in relation to other states and to the nation as a whole, and to adapt their prevention and control efforts to national or other state programs that have been shown to be effective.” – by Savannah Demko
Disclosure: Rosenberg reports grants from CDC, and personal fees from Medidata Inc. and Cengage Learning. Please see the full study for a complete list of all other authors’ relevant financial disclosures.