Awareness of chronic viral hepatitis in the United States: An update from the National Health and Nutrition Examination Survey

Abstract

Summary The World Health Organization has set the goal of reducing the hepatitis‐related mortality rate by 65% between 2015 and 2030. Diagnosis and awareness of infection is the first essential step towards achieving this goal. Our study examined the current awareness rate of chronic viral hepatitis in the United States and the potentially associated factors. In the National Health Nutrition and Examination Survey 2013‐2016, there were 11 488 persons who participated in serology testing for chronic viral hepatitis. We defined chronic hepatitis B virus (HBV) infection by HbsAg, HBV past exposure by anti‐HBc and hepatitis C virus (HCV) infection by HCV RNA. At risk for significant fibrosis was determined by AST to Platelet Ratio Index >0.7. Awareness of chronic HBV infection, past HBV exposure and HCV infection were present in 33.9%, 11.7% and 55.6% of participants, respectively. Among HCV‐infected baby boomers, the awareness was in 61.5%. The awareness of HBV infection was significantly higher in individuals with high education level. Age group (40‐60 years), women, non‐Black race/ethnicity and those with high household income who were born in the United States with insurance plans tend to be aware of their infection. For HCV, awareness was the lowest in Hispanics and Asians, foreign‐born who lived below the federal poverty level and low education level. Awareness among chronic viral hepatitis patients at risk for significant fibrosis was 62.0% in HBV and 38.2% in HCV infection. In conclusion, current awareness of chronic viral hepatitis in the United States remains suboptimal. Active public health policy to identify persons at risk and provide appropriate management is warranted.

CDC Recommendations for Hepatitis C Screening Among Adults — United States, 2020

“…With an anti-HCV positivity prevalence of 3.25%, persons born in the 1945-1965 birth year cohort accounted for approximately three fourths of chronic HCV infections among U.S. adults during 1999-2008 (37). Approximately 45% of persons infected with HCV do not recall or report having specific risk factors (38). Included in the 2012 guidelines were recommendations for alcohol use screening and intervention for persons identified with HCV infection (5).…”

“…Existing strategies for hepatitis C testing have had limited success. The 2013-2016 surveys indicate only approximately 56% of persons with HCV infection reported having ever been told they had hepatitis C (38). Therefore, strengthened guidance for universal hepatitis C testing is warranted.…”

Defining the hepatitis C cure cascade in an Urban health system using the electronic health record

“…HCV prevalence is highest among persons born between 1945 and 1965 (2.6%), persons who inject drugs, males, non‐Hispanic Black persons, and persons with less education and family income . Only 55.6% of people with chronic HCV infection are aware of their infection . African American baby boomers and urban emergency departments have prevalence rates as high as 14% .…”

“…[1][2][3] Only 55.6% of people with chronic HCV infection are aware of their infection. 4 African American baby boomers and urban emergency departments have prevalence rates as high as 14%. [5][6][7] The opioid epidemic has driven a recent surge in acute cases of HCV, primarily in younger populations.…”

A Survey of the Knowledge of and Testing Rate for Hepatitis C in the General Population in South Korea

“…The low prevalence of anti-HCV (0.34%) in the young adult group (<30 years) and in the Jeju area (0.26%) in 2009 may be an explanation, and generally, a high education level and income were related to a high awareness and knowledge of diseases including HCV. [21][22][23] In terms of treatment, 57% of people thought HCV is curable with medication, which is far below the 95% of the real life efficacy of DAA, recently.…”