Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer.
Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia.
JAMA Netw Open. 2018 Dec 7;1(8):e186371. doi: 10.1001/jamanetworkopen.2018.6371.
Infection with hepatitis C virus (HCV) is a major cause of morbidity and mortality in the United States, and incidence has increased rapidly in recent years, likely owing to increased injection drug use. Current estimates of prevalence at the state level are needed to guide prevention and care efforts but are not available through existing disease surveillance systems.
To estimate the prevalence of current HCV infection among adults in each US state and the District of Columbia during the years 2013 to 2016.
DESIGN, SETTING, AND PARTICIPANTS: This survey study used a statistical model to allocate nationally representative HCV prevalence from the National Health and Nutrition Examination Survey (NHANES) according to the spatial demographics and distributions of HCV mortality and narcotic overdose mortality in all National Vital Statistics System death records from 1999 to 2016. Additional literature review and analyses estimated state-level HCV infections among populations not included in the National Health and Nutrition Examination Survey sampling frame.
State, accounting for birth cohort, biological sex, race/ethnicity, federal poverty level, and year.
State-level prevalence estimates of current HCV RNA.
In this study, the estimated national prevalence of HCV from 2013 to 2016 was 0.84% (95% CI, 0.75%-0.96%) among adults in the noninstitutionalized US population represented in the NHANES sampling frame, corresponding to 2 035 100 (95% CI, 1 803 600-2 318 000) persons with current infection; accounting for populations not included in NHANES, there were 231 600 additional persons with HCV, adjusting prevalence to 0.93%. Nine states contained 51.9% of all persons living with HCV infection (California [318 900], Texas [202 500], Florida [151 000], New York [116 000], Pennsylvania [93 900], Ohio [89 600], Michigan [69 100], Tennessee [69 100], and North Carolina [66 400]); 5 of these states were in Appalachia. Jurisdiction-level median (range) HCV RNA prevalence was 0.88% (0.45%-2.34%). Of 13 states in the western United States, 10 were above this median. Three of 10 states with the highest HCV prevalence were in Appalachia.
Using extensive national survey and vital statistics data from an 18-year period, this study found higher prevalence of HCV in the West and Appalachian states for 2013 to 2016 compared with other areas. These estimates can guide state prevention and treatment efforts.
在美国，丙型肝炎病毒（HCV）感染是发病率和死亡率的主要原因，近年来发病率迅速上升，可能是由于注射毒品使用的增加所致。需要在州一级估计当前 HCV 流行率，以指导预防和护理工作，但现有的疾病监测系统无法提供这些信息。
估计 2013 年至 2016 年美国各州和哥伦比亚特区成年人中当前 HCV 感染的流行率。
设计、地点和参与者：本调查研究使用统计模型，根据全国所有国家生命统计系统死亡记录中 HCV 死亡率和麻醉药过量死亡率的空间人口统计学分布和分布，将全国健康和营养检查调查（NHANES）的全国 HCV 流行率分配给各州。此外，还对国家健康和营养检查调查抽样框架中未包括的人群进行了文献综述和分析，以估计各州的 HCV 感染情况。
州，考虑到出生队列、生物性别、种族/族裔、联邦贫困水平和年份。
当前 HCV RNA 的州级流行率估计值。
在这项研究中，2013 年至 2016 年期间，NHANES 抽样框架中代表性的非机构化美国人口中 HCV 的全国流行率估计为 0.84%（95%CI，0.75%-0.96%），相当于 2035100（95%CI，1803600-2318000）人患有当前感染；考虑到未包括在 NHANES 中的人群，有 231600 人患有 HCV，调整后的流行率为 0.93%。九个州占所有 HCV 感染者的 51.9%（加利福尼亚州[318900]、德克萨斯州[202500]、佛罗里达州[151000]、纽约州[116000]、宾夕法尼亚州[93900]、俄亥俄州[89600]、密歇根州[69100]、田纳西州[69100]和北卡罗来纳州[66400]）；其中 5 个州位于阿巴拉契亚地区。辖区级中位数（范围）HCV RNA 流行率为 0.88%（0.45%-2.34%）。在 13 个美国西部州中，有 10 个州高于这一中位数。HCV 流行率最高的 10 个州中有 3 个州位于阿巴拉契亚地区。
本研究使用了 18 年的广泛国家调查和生命统计数据，发现 2013 年至 2016 年，西部和阿巴拉契亚州的 HCV 流行率高于其他地区。这些估计可以指导州级预防和治疗工作。
