A population-based study of chronic hepatitis C in immigrants and non-immigrants in Quebec, Canada

Abstract

Background: Immigrants originating from intermediate and high HCV prevalence countries may be at increased risk of exposure to hepatitis C infection (HCV) in their countries of origin, however they are not routinely screened after arrival in most low HCV prevalence host countries. We aimed to describe the epidemiology of HCV in immigrants compared to the Canadian born population.

Methods: Using the reportable infectious disease database linked to the landed immigration database and several provincial administrative databases, we assembled a cohort of all reported cases of HCV in Quebec, Canada (1998-2008). Underlying co-morbidities were identified in the health services databases. Stratum specific rates of reported cases/100,000, rate ratios (RRs) and trends over the study period were estimated.

Results: A total of 20,862 patients with HCV were identified, among whom 1922 (9.2%) were immigrants. Immigrants were older and diagnosed a mean of 9.8 ± 7 years after arrival. The Canadian born population was more likely to have behavior co-morbidities (problematic alcohol or drug use) and HIV co-infection. Immigrants from Sub-Saharan Africa, Asia and Eastern Europe had the highest HCV reported rates with RRs compared to non-immigrants ranging from 1.5 to 1.7. The age and sex adjusted rates decreased by 4.9% per year in non-immigrants but remained unchanged in immigrants. The proportion of HCV occurring in immigrants doubled over the study period from 5 to 11%.

Conclusions: Immigrants from intermediate and high HCV prevalence countries are at increased risk for HCV and had a mean delay in diagnosis of almost 10 years after arrival suggesting that they may benefit from targeted HCV screening and earlier linkage to care.

Keywords: Hepatitis C; Immigrant; Incidence; Rates; Viral hepatitis.

Fig. 1

Flow chart for hepatitis C cases identification and Cohorts’ creation

Fig. 2

Reported rates of HCV Cases/100,000 overall and in immigrants and non-immigrants (1998–2008). Between 1998 and 2008, the rate of reported HCV cases adjusted for age and sex decreased by 4.89% per year in non-immigrants (95% CI = 4.85–4.93; p <0.001) compared to a 0.27% annual increase in immigrants (95% CI = 0.03–0.51; p = 0.028)

Fig. 3

Reported rates of HCV cases/100,000 by sex and immigrant status (1998–2008). Between 1998 and 2008, the annual HCV cumulative incidence adjusted for age decreased by 5.21% per year in non-immigrant females and by 4.72% in non-immigrant males compared to 0.60% decrease in immigrant females and 1.18% annual increase in immigrant males (p <0.001)

Fig. 4

Reported rates of HCV cases /100,000 (95% CI) by region of origin