Cornell Studies Hepatitis C Populations Not Typically Tallied in Survey

New research highlights how government estimates on hepatitis C prevalence in the United States leave out about 1 million people from several groups not regularly included in the tally, say researchers from Cornell University.

The government estimates are from a 2014 report of the National Health and Nutrition Examination Survey (NHANES), a health assessment from a representative sample of the country’s population, according to an article posted on the university web site. Out of an estimated 3.6 million people who have the hepatitis C virus antibodies, the survey indicates that 2.7 million are currently infected with the virus.

Results of a study from Weill Cornell Medicine published this month in the journal Hepatology say that a closer analysis of data from various sources revealed that the government estimate excludes six populations, including some that are stigmatized and live on the margins of society. The study authors say that the number of US residents who have antibodies for hepatitis C is probably closer to or exceeding 4.6 million and that 3.5 million are infected.

"The populations that are uncounted in the national numbers are very disadvantaged populations, so not only do we miss the magnitude of the problem, but we also don't see how much more concentrated these problems are in people affected by economic disadvantage, ethnic discrimination, and challenges accessing care," first author Brian Edlin, MD, an associate professor of medicine at Weill Cornell Medicine, states in the article.

"We need to pay more attention to our research and surveillance of these populations, and find effective methods for reaching them and engaging them in the process of overcoming the health challenges that they face," added Edlin.

In examining the NHANES report and then looking beyond it, Cornell researchers conducted a systematic review of literature and publicly available records in hospital and prison databases to analyze the prevalence of hepatitis C among military personnel and people who are homeless, in prison, nursing homes, or living on Native American reservations. The authors point out that complete accuracy of disease assessment is “nearly impossible” among the homeless and similar populations and believe their figures likely underestimate prevalence of the virus in the US.

“The available data do not support a precise result, but we estimated that 1.0 million (range 0.4 million-1.8 million) persons excluded from the NHANES sampling frame have hepatitis C virus antibody, including 500,000 incarcerated people, 220,000 homeless people, 120,000 people living on Indian reservations, and 75,000 people in hospitals,” the authors state in the journal abstract. “Most are men. An estimated 0.8 million (range 0.3 million-1.5 million) are currently infected.”

This more accurate estimate of hepatitis C prevalence needs to be followed up with greater access of antiviral treatment to people from populations severely affected by the disease, states Edlin. Intervention efforts such as outreach, education, testing and counseling are vital to contain bloodborne viral disease epidemics, according to the article.

The journal Hepatology first published the study results online Aug. 25.