Primary Care Development Corporation, 45 Broadway, New York, NY, 10006, USA.
Bureau of Communicable Diseases, New York City Department of Health and Mental Hygiene, Long Island City, NY, 11101, USA.
J Urban Health. 2017 Oct;94(5):746-755. doi: 10.1007/s11524-017-0174-x.
Deaths attributable to hepatitis C (HCV) infection are increasing in the USA even as highly effective treatments become available. Neighborhood-level inequalities create barriers to care and treatment for many vulnerable populations. We seek to characterize citywide trends in HCV mortality rates over time and identify and describe neighborhoods in New York City (NYC) with disproportionately high rates and associated factors. We used a multiple cause of death (MCOD) definition for HCV mortality. Cases identified between January 1, 2006, and December 31, 2014, were geocoded to NYC census tracts (CT). We calculated age-adjusted HCV mortality rates and identified spatial clustering using a local Moran's I test. Temporal trends were analyzed using joinpoint regression. A multistep global and local Poisson modeling approach was used to test for neighborhood associations with sociodemographic indicators. During the study period, 3697 HCV-related deaths occurred in NYC, with an average annual percent increase of 2.6% (p = 0.02). The HCV mortality rates ranged from 0 to 373.6 per 100,000 by CT, and cluster analysis identified significant clustering of HCV mortality (I = 0.23). Regression identified positive associations between HCV mortality and the proportion of non-Hispanic black or Hispanic residents, neighborhood poverty, education, and non-English-speaking households. Local regression estimates identified spatially varying patterns in these associations. The rates of HCV mortality in NYC are increasing and vary by neighborhood. HCV mortality is associated with many indicators of geographic inequality. Results identified neighborhoods in greatest need for place-based interventions to address social determinants that may perpetuate inequalities in HCV mortality.
尽管美国有高效的治疗方法，但丙型肝炎（HCV）感染导致的死亡人数仍在增加。邻里不平等现象给许多弱势群体的护理和治疗带来了障碍。我们旨在描述 HCV 死亡率随时间的全市趋势，并确定和描述纽约市（NYC）中丙型肝炎死亡率过高的社区及其相关因素。我们使用多病因死亡（MCOD）定义来确定 HCV 死亡率。2006 年 1 月 1 日至 2014 年 12 月 31 日期间确定的病例被地理编码到纽约市的普查区（CT）。我们计算了年龄调整后的 HCV 死亡率，并使用局部 Moran's I 检验确定了空间聚类。使用 Joinpoint 回归分析了时间趋势。采用多步骤全球和局部泊松模型方法，检验了与社会人口指标相关的社区关联。在研究期间，NYC 有 3697 例与 HCV 相关的死亡，平均每年增长 2.6%（p=0.02）。HCV 死亡率范围为每 100,000 人中有 0 至 373.6 人，聚类分析确定 HCV 死亡率存在显著聚类（I=0.23）。回归分析发现 HCV 死亡率与非西班牙裔黑人或西班牙裔居民比例、邻里贫困、教育和非英语家庭之间存在正相关关系。局部回归估计确定了这些关联的空间变化模式。NYC 的 HCV 死亡率正在上升，且因社区而异。HCV 死亡率与许多地理不平等的指标有关。结果确定了最需要进行基于地点的干预的社区，以解决可能使 HCV 死亡率不平等持续存在的社会决定因素。
