BACKGROUND: Chronic hepatitis C virus (HCV) infection is a substantial public health problem in New York City (NYC), with an estimated 2.4% of adults infected. The availability of highly effective cures underscores the importance of a public health approach to this disease. The NYC Department of Health and Mental Hygiene (DOHMH) leveraged resources, including electronic disease surveillance and cancer registry data, to create a NYC epidemiologic profile for HCV infection.
METHODS: We conducted descriptive analyses of HCV cases newly reported in 2014 by various demographic and geographic characteristics. Zip code-based poverty level, per the American Community Survey 2008–2012, was used to examine associations with poverty. The association with hepatocellular carcinoma (HCC) was examined by matching New York State Cancer Registry data from 2001 to 2012 to viral hepatitis surveillance data from 1999 to 2012. To assess co-infections, data from 2000 to 2013 were matched across DOHMH surveillance registries, including HIV, hepatitis C, and hepatitis B. Rates per 100,000 people were calculated.
RESULTS: In 2014, 7,691 persons were newly reported with HCV infection. Rates were higher among men (115.7) than women (69.4) and among those 50-59 and 60-69 years old (194.4 and 224.2, respectively) than among 40-49 year-olds (107.8) and 30-39 year-olds (84.1). Rates were higher in zip codes with high (20-29%) or very high (30% or more) percentages of residents living below the federal poverty threshold (83.5 and 103.1, respectively) compared with rates in low poverty (<10%) areas (59.2). In 2001-2012, 3,392 persons with HCV infection were diagnosed with HCC. Of those, most (74.5%) were men. Two thirds were Hispanic (35.0%) or non-Hispanic Black (30.1%), followed by non-Hispanic White (29.1%), and Asian/Pacific Islander (5.3%). More than half (55.9%) of HCV-HCC cases resided in high or very high poverty areas. There were 160,854 persons with HCV infection in the cross-registry matched dataset. Of these, 14.4% were infected with HIV, compared with approximately 1.4% of New Yorkers overall, and 3.2% were co-infected with hepatitis B virus.
CONCLUSIONS: The burden of HCV infection in NYC is unequally distributed, with higher rates among men and residents of high poverty areas. A high proportion of HCV-HCC cases occur among minorities, and HIV infection is higher among those with HCV than in the population overall. These findings underscore the need for public health interventions to address disparities and the importance of surveillance data to monitor their impact.