BACKGROUND: Nebraska is experiencing a steady increase in people diagnosed with Hepatitis C (HCV). Increases in the rate of new HCV infections are largely being driven by the emerging epidemic of opiate abuse and baby boomers (born from 1945-1965). The purpose of this project is to describe HCV disparities in terms of concentrated disadvantage and age group. Concentrated disadvantage captures the synergistic effects of economic and social factors that cluster geographically. Neighborhoods with high concentrated disadvantage can have limited access to resources, social networks, and expose people to negative social conditions and poor health outcomes. Current HCV treatment cures around 95% of patients so it is important to understand and address HCV disparities to make sure HCV education, testing, care, and treatment opportunities are not missed.
METHODS: Concentrated disadvantage was calculated from five census variables: percent of individuals below the poverty line, percent on public assistance, percent of female-headed households, percent of adults unemployed, and percent under the age of 18. 2011-2015 data were obtained from the American Community Survey for Nebraska census tracts. Z-scores were calculated for each variable, summed for each census tract to create a tract-specific concentrated disadvantage score, then split into low, medium low, medium high, and high quartiles. These quartiles were mapped. Next we calculated census tract level HCV rates from 2011-2015 for the following age groups: 15 to 29, 30 to 49, 50 to 69 and 70+. Each case was geocoded with the concentrated disadvantage scores.
RESULTS: Areas of high concentrated disadvantage were identified mostly in urban metro areas, Native American reservations, and a few rural farming communities. The highest HCV rates were found in 30 to 49 year olds and 50 to 69 year olds. The 50 to 69 year olds have almost twice the rates as the other age groups. Census tracts with the highest level of concentrated disadvantage had the highest rates of HCV for all age groups.
CONCLUSIONS: Mapping concentrated disadvantage helps communities go beyond focusing on individual behaviors to recognizing the biological, behavioral, psychological, and environmental factors that impact health. Describing HCV burden and disparities in terms of concentrated disadvantage guides the Nebraska Department of Health and Human Services to identify focus areas for testing, work with partners serving populations with the highest HCV prevalence, and educate the public, providers, and stakeholders about HCV.