Rosenberg Eli S, Hall Eric W, Sullivan Patrick S, Sanchez Travis H, Workowski Kimberly A, Ward John W, Holtzman Deborah
Department of Epidemiology, Emory University Rollins School of Public Health.
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine; and.
Clin Infect Dis. 2017 Jun 1;64(11):1573-1581. doi: 10.1093/cid/cix202.
BACKGROUND.: Hepatitis C virus (HCV) infection is the most common chronic blood-borne infection in the United States and a leading cause of morbidity and mortality. Previous analyses of the US National Health and Nutrition Examination Survey (NHANES) indicated approximately 3.6 million noninstitutionalized persons with antibody to HCV (anti-HCV). However, state-level prevalence remains less understood and cannot be estimated reliably from NHANES alone.
METHODS.: We used 3 publicly available government data sources to estimate anti-HCV prevalence in each US state among noninstitutionalized persons aged ≥18 years. A small-area estimation model combined indirect standardization of NHANES-based prevalence with logistic regression modeling of mortality data, listing acute or chronic HCV infection as a cause of death, from the National Vital Statistics System during 1999-2012. Model results were combined with US Census population sizes to estimate total number and prevalence of persons with antibody to HCV in 2010.
RESULTS.: National anti-HCV prevalence was 1.67% (95% confidence interval [CI], 1.53-1.90), or 3 911 800 (95% CI, 3 589 400- 4 447 500) adults in 2010. State-specific prevalence ranged from 0.71% (Illinois) to 3.34% (Oklahoma). The West census region had the highest region-specific prevalence (2.14% [95% CI, 1.96-2.48]); 10 of 13 states had rates above the national average. The South had the highest number of persons with anti-HCV (n = 1561600 [95% CI, 1 427 700-1 768 900]). The Midwest had the lowest region-specific prevalence (1.14% [95% CI, 1.04%-1.30%]).
CONCLUSIONS.: States in the US West and South have been most impacted by hepatitis C. Estimates of HCV infection burden are essential to guide policy and programs to optimally prevent, detect, and cure infection.
丙型肝炎病毒（HCV）感染是美国最常见的慢性血源性感染，也是发病和死亡的主要原因。此前对美国国家健康与营养检查调查（NHANES）的分析表明，约有360万非机构化人群存在丙型肝炎病毒抗体（抗-HCV）。然而，州层面的患病率仍了解较少，无法仅根据NHANES可靠估算。
我们使用3个公开的政府数据源来估算美国各州≥18岁非机构化人群中的抗-HCV患病率。一种小区域估计模型将基于NHANES的患病率间接标准化与死亡率数据的逻辑回归建模相结合，将急性或慢性HCV感染列为1999 - 2012年期间国家生命统计系统中的死亡原因。模型结果与美国人口普查人口规模相结合，以估算2010年抗-HCV人群的总数和患病率。
2010年全国抗-HCV患病率为1.67%（95%置信区间[CI]，1.53 - 1.90），即3911800名成年人（95%CI，3589400 - 4447500）。各州特定患病率从0.71%（伊利诺伊州）到3.34%（俄克拉荷马州）不等。西部人口普查地区的特定地区患病率最高（2.14%[95%CI，1.96 - 2.48]）；13个州中有10个州的患病率高于全国平均水平。南部抗-HCV人数最多（n = 1561600[95%CI，1427700 - 1768900]）。中西部地区特定患病率最低（1.14%[95%CI，1.04% - 1.30%]）。
美国西部和南部各州受丙型肝炎影响最大。HCV感染负担的估计对于指导最佳预防、检测和治愈感染的政策和计划至关重要。
