Disparities in hepatitis C among people aged 12-59 with no history of injection drug use, United States, January 2013-March 2020

Abstract

Background and aims: In the United States, hepatitis C virus (HCV) infection occurs primarily through injection drug use (IDU), but transmission also occurs through other ways. This study examined HCV prevalence and disparities among US residents aged 12-59 years with no IDU history.

Methods: We analysed 2013-March 2020 National Health and Nutrition Examination Survey data to calculate the HCV prevalence among people with no drug use history and only a non-IDU history, collectively referred to as no IDU history. These estimates were compared to those with an IDU history and stratified by sociodemographic and hepatitis A and hepatitis B serologic characteristics.

Results: The current HCV infection prevalence among people aged 12-59 was .7% overall, and specifically 17.2% among people with an IDU history, .9% among people with a non-IDU history and .2% among people with no drug use history. These rates represented 1.4 million people with current HCV infection, of whom, 730 000 had an IDU history, 262 000 had a non-IDU history and 309 000 had no drug use history. Among people with no drug use history, current HCV infection prevalence was higher for people born during 1954-1965 versus after 1965, had completed high school or less versus at least some college and had past/present hepatitis B versus vaccinated for hepatitis B.

Conclusion: While the HCV infection burden was highest among people with an IDU history, we found a sizeable burden among people without such a history. These findings support policies and practices aimed at addressing disparities among people needing treatment.

Keywords: HCV; disparities; hepatitis C; non‐traditional risk factors; prevalence.

FIGURE 1

Hepatitis C virus infection testing algorithm^a and classification, National Health and Nutrition Examination Survey, January 2013–March 2020. Data source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination Survey, January 2013–March 2020 (pre-COVID-19 pandemic data). Anti-HCV, HCV antibody; HCV, hepatitis C virus. ^aAll viral hepatitis laboratory testing was performed per its laboratory procedure manual, and the need for retesting was determined using signal-to-cutoff results defined by standard testing protocols.

FIGURE 2

Prevalence (%) of past or present hepatitis C virus infection^a among people aged 12–59 years by birth year cohort and drug use status, United States, January 2013–March 2020. Data source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination Survey, January 2013–March 2020 (pre-COVID-19 pandemic data). IDU, injection drug use. ^aClassified based on either (1) an HCV RNA-positive result (current infection) or (2) a screening anti-HCV-positive specimen that was HCV RNA-negative but confirmed anti-HCV-positive (cleared infection). ^bEstimate does not meet NCHS standards for the presentation of proportions because the confidence interval width is more than 30%.