Kim W Ray
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, MN, USA.
Hepatology. 2002 Nov;36(5 Suppl 1):S30-4. doi: 10.1053/jhep.2002.36791.
According to the third National Health and Nutrition Examination Survey (NHANES), 3.9 million of the U.S. civilian population have been infected with hepatitis C virus (HCV), of whom 2.7 million (74%) have chronic infection. Hepatitis C virus infection is most common among non-Caucasian men, ages 30 to 49 years. Moreover, the prevalence of antibody to hepatitis C virus in groups not represented in the NHANES sample, such as the homeless or incarcerated, may be as high as 40%. The age-adjusted death rate for non-A, non-B viral hepatitis increased from 0.4 to 1.8 deaths per 100,000 persons per year between 1982 and 1999. In 1999, the first year hepatitis C was reported separately, there were 3,759 deaths attributed to HCV, although this is likely an underestimate. There was a 5-fold increase in the annual number of patients with HCV who underwent liver transplantation between 1990 and 2000. Currently, more than one third of liver transplant candidates have HCV. Inpatient care of HCV-related liver disease has also been increasing. In 1998, an estimated 140,000 discharges listed an HCV-related diagnosis, accounting for 2% of discharges from non-federal acute care hospitals in the United States. The total direct health care cost associated with HCV is estimated to have exceeded $1 billion in 1998. Future projections predict a 4-fold increase between 1990 and 2015 in persons at risk of chronic liver disease (i.e., those with infection for 20 years or longer), suggesting a continued rise in the burden of HCV in the United States in the foreseeable future.
根据第三次全国健康和营养检查调查（NHANES），美国有390万平民感染了丙型肝炎病毒（HCV），其中270万（74%）为慢性感染。丙型肝炎病毒感染在30至49岁的非白种男性中最为常见。此外，在NHANES样本中未涵盖的群体，如无家可归者或被监禁者，丙型肝炎病毒抗体的患病率可能高达40%。1982年至1999年间，非甲非乙型病毒性肝炎的年龄调整死亡率从每年每10万人0.4例死亡增至1.8例死亡。1999年，丙型肝炎首次单独报告的那一年，有3759例死亡归因于HCV，不过这可能是低估了。1990年至2000年间，接受肝移植的HCV患者数量每年增长了5倍。目前，超过三分之一的肝移植候选者患有HCV。与HCV相关的肝病的住院治疗也一直在增加。1998年，估计有14万例出院病例列出了与HCV相关的诊断，占美国非联邦急症护理医院出院病例的2%。1998年，与HCV相关的直接医疗总成本估计超过了10亿美元。未来预测显示，1990年至2015年间，慢性肝病风险人群（即感染20年或更长时间的人群）将增加4倍，这表明在可预见的未来，美国HCV的负担将持续上升。
