Racial differences in age at Hepatitis C diagnosis in Marion County, Indiana: 2009-2013

Background

Hepatitis C affects an estimated 3.2 million persons in the United States. The Marion County Public Health Department (MCPHD) has 9,131 cases (2005-2014) on file in a county of 928,000 people. Many infected with HCV in Indianapolis are unaware of their status even with conservative estimates. It is important to identify the carriers of this disease in order to limit its spread as well as initiate treatment to prevent costly complications including cirrhosis and hepatocellular carcinoma.

Methods

Retrospective analysis of 2009-2013 Marion County HCV records was conducted. All cases had physician and/or laboratory diagnosis. Diagnoses among Black and White residents were compared by year, race, gender, and age. Chi-square analysis for group comparisons and log-transformed correlations for relative-risk trends were performed.

Results

A total of 4,086 diagnoses, 35.6% Black and 38.9% female, were reported. Overall relative risk (RR) of HCV diagnosis for Blacks vs. Whites was 1.37 (CI 1.2876—1.4630); RR of HCV diagnosis for males vs. females was 1.70 (CI 1.5932—1.8061). The age distribution of Whites vs. Blacks and females vs. males were significantly different (χ² p<0.001, p<0.001 respectively). When compared to Whites, the age and race corrected rates for Blacks were low until the age of 40; then the rates increased significantly with age. These trends were similar for all years examined. The baby boomers with high HCV infection rates were evident in both racial groups but these were much more prominent in Blacks. The RR values were 1.32, 0.56, 0.40, 0.43, 1.30, 2.46, 5.60 and 4.90 for age groups 0-9 to 70-79 when all cases were combined. The RR values increased steadily 2-fold per decade from age group 20-29 to 60-69 (r=0.98).

Conclusion

Our data suggest Blacks are diagnosed with hepatitis C significantly later than Whites. Racial disparity is relatively small when overall rates are calculated; however age specific rates are strikingly different when distributions are considered. While these data warrant further investigation into the social determinants for later diagnosis, they also suggest investigation of health system interventions to improve testing and diagnosis for higher risk populations. Given a highly successful treatment for HCV is available now, this research may also help public health practitioners with their future HCV programs and policy decisions. Earlier detection will lead to better outcomes, higher quality of life, and lower health care costs.