By: Marcus J. Hopkins, Policy Consultant
For much of HEAL Blog’s nearly six years, I have been banging the drum about Hepatitis C (HCV) infection rates in rural Appalachia so loudly that our neighbors have filed several noise complaints. Each year, around this time, both state Departments of Epidemiology and the Centers for Disease Control and Prevention (CDC) begin issuing the Acute HCV infection rates for the U.S. from two years prior (e.g. – in 2019, the figures for 2017 will be released), and between February and June, I spent much of my time trying to convince legislators, infectious disease advocates, HIV advocates, and local politicians about why it is vital to pay better attention to this disease.
For example, West Virginia – my home state – recently released a horrifying graphic: from 2016 to 2017, our rate of Acute HCV infections rose from 5.1 (out of 100,000) in 2016 to a staggering 9.1 in 2017(West Virginia Electronic Disease Surveillance System (WVEDSS), 2018). While these data are provisional (meaning that the finalized rate may be slightly lower), a 4-point increase in infection rates goes beyond a “call for alarm,” and into “disaster simulation” territory. Surrounding states – namely Ohio and Kentucky, as well as the District of Columbia – share equally troubling infection rates.
New findings published in the Journal of the American Medical Association Network Open indicate that, outside of Acute HCV infection incidence, HCV prevalence rates are high in several Appalachian and Western states. A total of 9 states (CA, TX, FL, NY, PA, OH, MI, TN, and NC) accounted for more than half (51.9%) of all persons living with HCV infection between 2013 to 2016 (Masoud, 2019).
So, what makes these prevalence numbers so different from infection rates (incidence)? For one thing, population. Incidence rates can be used to determine the likelihood or risk that someone will contract a disease. In states with a smaller population (like West Virginia), even though fewer people are contracting a given disease, the incidence rate will be higher than in a state where more individuals contract a new infection, but the population is exponentially larger.
For example: in 2016, there were 94 confirmed new Acute HCV infections in West Virginia, which had a population of 1,829,000, resulting in an incidence rate of 5.1 (out of 100,000 people); in New York, however, there were 179 confirmed new Acute HCV infections, but the population, there, was 8,615,000, resulting in an incidence rate of 0.9. The roughly 7 million additional people in the state lowers the risk of infection significantly.
With prevalence, we’re looking at the number of people who are living with a disease, regardless of whether or not they became infected during a specific year. So, if we are looking at a period of time – 2013 to 2016, for instance – anyone who was living with HCV during those years is counted in a prevalence count, even if they were notnewly infected during one of those years. To break it down in easier terms, “incidence” tells us the number of newly infected persons in a given year/period, whereas “prevalence” tells us how many people were living with the disease at that time.
What the JAMA Network Open study found was that the U.S. national prevalence for HCV from 2013-2016 was 0.84% in American adults who were not institutionalized and was adjusted upwards to 0.93% to account for those populations not included (Masoud). States whose prevalence rates were above that national average includes: AZ (1.10%), CA (0.99%), DC (2.32%), KY (1.16%), LA (1.30%), NM (1.61%), OK (1.71%), OR (1.48%), RI (1.16%), TN (1.28%), and WV (1.35%). Of these states, four are Western (AZ, CA, NM, and OR), and four are Appalachian (DC, KY, TN, and WV).
These findings indicate the need for additional resources, research, and outreach in Appalachia and the American West. Moreover, the study’s conclusion states that:
Prevalence of HCV infection varies widely in the United States. Highest rates are frequently in states deeply affected by the opioid crisis or with a history of increased levels of injection drug use and chronic HCV infection, particularly in the West. Progress toward hepatitis C elimination is theoretically possible with the right investments in prevention, diagnosis, and cure.
Truer words have rarely been spoken.
- Masoud, Z. (2019, January 31). High Hepatitis C Prevalence in Western and Appalachian US States. New York, NY: Haymarket Media, Inc.: Infectious Disease Advisor: Hepatitis. Retrieved from: https://www.infectiousdiseaseadvisor.com/hepatitis/higher-rates-of-hcv-cases-in-regional-parts-of-america/article/830287/
- West Virginia Electronic Disease Surveillance System. (2018, July 01). Acute Hepatitis C Incidence Rate, 2007-2017. Charleston, WV: West Virginia Department of Health and Human Resources: Office of Epidemiology and Prevention: Hepatitis C: Data and Surveillance. Retrieved from: https://oeps.wv.gov/HCV/documents/data/acute_hcv_chart.pdf
Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.