A population-based study of chronic hepatitis C in immigrants and non-immigrants in Quebec, Canada

Abstract

BackgroundImmigrants originating from intermediate and high HCV prevalence countries may be at increased risk of exposure to hepatitis C infection (HCV) in their countries of origin, however they are not routinely screened after arrival in most low HCV prevalence host countries. We aimed to describe the epidemiology of HCV in immigrants compared to the Canadian born population.MethodsUsing the reportable infectious disease database linked to the landed immigration database and several provincial administrative databases, we assembled a cohort of all reported cases of HCV in Quebec, Canada (1998–2008). Underlying co-morbidities were identified in the health services databases. Stratum specific rates of reported cases/100,000, rate ratios (RRs) and trends over the study period were estimated.ResultsA total of 20,862 patients with HCV were identified, among whom 1922 (9.2%) were immigrants. Immigrants were older and diagnosed a mean of 9.8 ± 7 years after arrival. The Canadian born population was more likely to have behavior co-morbidities (problematic alcohol or drug use) and HIV co-infection. Immigrants from Sub-Saharan Africa, Asia and Eastern Europe had the highest HCV reported rates with RRs compared to non-immigrants ranging from 1.5 to 1.7. The age and sex adjusted rates decreased by 4.9% per year in non-immigrants but remained unchanged in immigrants. The proportion of HCV occurring in immigrants doubled over the study period from 5 to 11%.ConclusionsImmigrants from intermediate and high HCV prevalence countries are at increased risk for HCV and had a mean delay in diagnosis of almost 10 years after arrival suggesting that they may benefit from targeted HCV screening and earlier linkage to care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-017-2242-y) contains supplementary material, which is available to authorized users.

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“…[33][34][35] Mortality rates were generally lower among immigrants than among long-term residents, consistent with the "healthy immigrant effect," whereby new immigrants are typically healthier than those native to a country, 36 including in Canada. 37,38 Greenaway and colleagues 39 found that immigrants in Quebec had lower rates of problematic drug use than nonimmigrants, which may further explain our finding. Rural residents had a greater risk for all-cause mortality, which confirms previous research among people with HIV infection.…”

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“…This finding is consistent with the previous studies that showed immigrants were diagnosed with their liver disease after almost 10 years following arrival and at more advanced stage. [24][25][26][27][28] This may be due to lack of healthcare access and health information, poor knowledge of the disease and asymptomatic disease progression.…”

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“…More recently an EDbased, nontargeted, opt-out study found an HCV-positive rate of 7.7%, revealing a significant number of infected patients who did not have traditional risk factors [25]. Additionally, our findings may be an underestimate given the high rate of refusal, and especially the significantly higher number of immigrant patients amongst those who refused testing, since rates of HCV infection amongst immigrants from endemic countries is estimated to be up to 1.7 times higher than non-immigrants [26].…”