Prevalence, diagnosis, treatment, and associated factors of hepatitis C in the United States from 1999 to 2018: A population-based cross-sectional study

Abstract

Background and aim

Hepatitis C virus (HCV) infection is one of the major global health challenges, leading to a significant increase in rates of hepatic fibrosis, cirrhosis and hepatocellular carcinoma. A comprehensive nationwide survey of trends in prevalence and associated factors could facilitate preventive behavioral interventions. Herein, we sought to determine prevalence, diagnosis, treatment, and risk factors for HCV infection in the general United States (US) population.

Methods

This was a secondary analysis of the publicly available data from the US National Health and Nutrition Examination Survey (NHANES). The prevalence of HCV-RNA-positive (HCV-RNA+) was weighted using patient serum sample data collected from 1999 to 2018. A propensity score matching model was used due to the imbalance in the number of HCV-RNA+ and HCV-RNA-negative (HCV-RNA−) patients. Matched variables included gender, age, educational level, marital status, language, household size, alcohol consumption, smoking, number of family members and family income to poverty ratio.

Results

The weighted prevalence of HCV-RNA+ was 1.11% (95% confidence interval (CI): 1.02–1.20), 1.58% (95% CI: 1.42–1.74) for men and 0.67% (95% CI: 0.57–0.77) for women aged 20 years or older in the US from 1999 to 2018. The weighted prevalence of HCV-RNA+ increased from 0.87% (95% CI: 0.62–1.12) in 2013–2014, 0.95% (95% CI: 0.68–1.22) in 2015–2016 to 1.00% (95% CI: 0.72–1.28) in 2017–2018, respectively. In propensity-matched analysis, patients with HCV-RNA+ were more likely to be non-Hispanic black, and have had drug use and blood transfusions. Meanwhile, the weighted diagnostic and treatment rates were 56.27% (95% CI: 50.90–61.64) and 35.40% (95% CI: 27.64–43.16) from 1999 to 2018, respectively.

Conclusions

Active HCV infection rate increased between 2013 and 2018, varied by demographic and risk variables. In the direct-acting antiviral era, affordable treatment and universal screening have the potential to improve overall national health.