Hepatitis C Prevalence in the US by Age, Gender, and Race

"Modeled Hepatitis C prevalence estimates varied meaningfully by demographic characteristics, within and across U.S. jurisdictions. In most jurisdictions, we estimated higher disease prevalence among males compared with females, persons born during 1945 to 1969 compared with older or younger persons, and non-Hispanic black persons compared with persons of other race/ethnicities. Reducing the overall number of HCV infections with a focus on disparities requires an understanding of both hepatitis C prevalence and number of infections in high-risk populations.

"HCV infections are increasing among young, mostly white persons in rural areas who inject drugs,1, 24, 25 but our analysis suggests that non-Hispanic blacks continue to have larger proportions of prevalent infections in most jurisdictions. Nationally, an estimated 72% of prevalent HCV infections occurred among persons born during 1945 to 1969, and even in states like West Virginia and Kentucky with higher than average percentages of infections among young people, more than 50% of all infections were still among persons born during 1945 to 1969 based on these estimates. Jurisdictions with future growth in hepatitis C burden, however, may be those with the highest prevalence of opioid-use disorder and associated injection drug use. This pattern begins to emerge to some extent in our results, in which many jurisdictions with higher than average overall prevalence are also those with larger percentages of infections among the youngest age group (e.g., New Mexico, West Virginia, Kentucky, Ohio).

"We also observed that model-based hepatitis C prevalence was more than twice as prevalent among non-Hispanic black persons than among persons of other race/ethnicities, and in 15 jurisdictions, was at least 3 times as high. This disparity has been shown previously,18 and these estimates suggest racial disparities in hepatitis C have not declined since 2010. Higher prevalence among non-Hispanic blacks compared with persons of other race/ethnicities likely stems from a combination of factors including lower rates of acute hepatitis C clearance,26-28 higher rates of incarceration,29-33 and less access to effective treatment services.34-36 Clinical evidence suggested that interferon-based therapies were less effective for treating genotype 1 HCV infection among non-Hispanic black versus persons of other race/ethnicities, but newer direct-acting antiviral medications provide equally effective treatment across racial groups.37 Efforts are urgently needed to reduce racial disparities in hepatitis C burden by increasing treatment rates among non-Hispanic black Americans through improved health coverage and development of culturally appropriate care and treatment interventions.37, 38"