Statistics

May, 2015

How many people have hepatitis C? Who has it? Where do they live? We at HepCBC went through the latest statistics about hepatitis C in BC, in Canada, and the World. They’re not perfect because not everyone who has hepatitis C has been tested, and not all cases are reported, especially in less-developed countries. But with a cure now available and the eventual eradication of hepatitis C an achievable goal, governments are starting to collect better data allowing them to better target their resources. Here is a summary of the most recent statistics:

IN BC (from BC Centre for Disease Control, PHAC, Statistics Canada, and BC Centre for Excellence in HIV/AIDS):

There are approximately 80,000 people with HCV in British Columbia. BC has one of the highest (perhaps the highest) rate of new cases per year (incidence) in Canada. There appears to be approximately the same proportions of infected people in the categories described above for Canada as a whole. Recently BC Centre for Disease Control released a new table titled “HCV Cases among Immigrants BC & Canada”. Based on published “2013: HCV Rates” data published by Statistics Canada, this graph showed that the prevalence among immigrants in both Canada and BC is approximately 3%. It showed that approximately 18,883 of the 80,000 cases of hepatitis C in BC are among immigrants from Eastern Asia, SE Asia, and Southern Asia – those represented include (in order of number) people from China, India, Philippines, Taiwan, and Vietnam. While Vietnam has only an estimated 1608 HCV+ people in BC, it has the highest rate of prevalence among BC immigrants (6.1%).

Sources: www.cfenet.ubc.ca/sites/default/files/uploads/HCV%20Fact%20Sheet.pdf

www.phac-aspc.gc.ca/sti-its-surv-epi/hepc/pdf/hepc-2010-eng.pdf and

BC Centre for Disease Control Power Point slide – permission given by author and available on request to HepCBC

 

IN CANADA (from Public Health Agency of Canada [PHAC], Canada Communicable Disease Report [CCDR] Volume 40-19, Dec. 18, 2014 and Canadian Liver Foundation):

Depending on whom you talk to, the number of people with chronic hepatitis C (CHC) in Canada can be anywhere from 220,000 to approximately twice that number. The Canadian Liver Foundation estimates that 250,000 Canadians were currently infected with the virus (2013), but that number could include those who test positive but have cleared the disease, either on their own (generally in the first six months of infection) or through treatment. The percentage of the population living with CHC (prevalence), and the % of this population which does not realize they have CHC (undiagnosed) can vary widely as well. A 2013 Canadian Health Measures Survey (PHAC, 2013) was strongly criticized because data from several provinces was missing and members of key populations such as intravenous drug users, immigrants from countries with high HCV prevalence, the homeless, aboriginal people and prisoners were under-represented. This new report tries to address the limitations of the previous survey by using statistical methods such as a “back-calculation model” (for more details on this see link below). The results were quite fascinating! In the report Hepatitis C in Canada, by  Cheryl Reitz, MA & CD Mazoff, PhD, the figure was adjusted to 280,000 for 2014.  See also the HepCBC presentation: Hepatitis C in Canada: Connecting the Dots.

2014 PHAC study concluded between 0.64% and 0.71% of Canada’s population were living with CHC in 2011. This is 220,697 people, and 44% of them were undiagnosed.

Birth cohorts most affected by CHC (followed by prevalence in %): 1950-1954 (1.25%); 1955-1969 (1.5%); 1960-1964 (1.2%); 1965-1969 (1.1%); and 1970-1974 (0.8%).

NOTE: The prevalence in cohorts previous to 1950 has actually declined to below the national average. The author assumes this is likely due to deaths which could be related to CHC in this aging population. Though the 1945-1949 cohort may now contain lower than average prevalence, those with CHC remaining in this cohort are the most in danger of dying from this disease. The sooner we find and treat them, the more cases of liver cancer and liver failure will be averted and the more quality years of life these people will be able to have. (On a personal note: the author of this article is a person born in 1948 who was recently cured of hepatitis C with the new DAA drugs, and feels incredibly fortunate and grateful for this extra lease on life!)

Who has hepatitis C in Canada? Nine groups in order of the total number of people with CHC (followed by the % prevalence) are the following:

  • Foreign-born, ages 14-79 (116,428 – 1.9%);
  • Former IDU, ages 14-79 (75,602, – 28.5%);
  • Current IDU (66,000 – 66%);
  • Non-aboriginal, non-foreign-born, non-IDU ages 14-79 (39,711 – 0.2%);
  • Provincial inmates, including youth (9,287 – 23.25%);
  • Residents of nursing homes & long-term care hospitals (8,832 – 2.95%);
  • Aboriginal, non IDU (6,115 – 0.5%);
  • Homeless, non IDU (4,072 – 2.25%);
  • Federal inmates, including youth (3,493 – 24%).

NOTE 1: The foreign-born statistic should be split into those who are from countries or regions with high prevalence versus those who are not. This would show a far higher % prevalence among those from certain countries (see previous “WORLD” section).

NOTE 2: Many of those who are foreign-born, former IDU, aboriginal, homeless, or residents of nursing homes are also “Baby Boomers.” One-time-only testing of “Baby Boomers” would locate approximately 67% – 75% of all those with hepatitis C, including those from all of the groups above.

 What % of the CHC population remains un-diagnosed? Various studies have tested members of specific groups and found that of those in the group who tested positive for CHC, the following % of each group did not previously know they had CHC:

  • Drug users = 20% to 43% undiagnosed;
  • Hospital patients = 56% undiagnosed;
  • Inmates = 28% – 50% undiagnosed;
  • First-time blood donors = 48% – 58% undiagnosed;
  • Men who have Sex with Men (MSM) = 44% – 75% undiagnosed;
  • US Population = 50.3% undiagnosed;
  • Canadian household, population ages 14 – 79 = 70% undiagnosed.

(Canadian Health Measures Survey – CHMS: Health Reports 2013; 24 11): 3-13)

Sources:

www.phac-aspc.gc.ca/publicat/ccdr-rmtc/14vol40/dr-rm40-19/surveillance-b-eng.php and

www.liver.ca/support-liver-foundation/advocate/clf-position-statements/hepatitis_C_testing.aspx

 

IN THE WORLD (from European Assn. for Study of the Liver [EASL] –2014 vol. 61 j S45–S57):

115 million people now living in the world (1.6% of the population) have been exposed to hepatitis C virus (have HCV antibodies), of whom 80 million have chronic hepatitis C (CHC).

The top-ten countries in order from greatest to least number of people with CHC are China, Pakistan, Nigeria, Egypt, India, Russia, USA, Brazil, Congo, and Japan. NOTE: Egypt, with 15% of its population suffering from CHC, has the highest prevalence of any country. However, because its total population is so much smaller than China, China has far more infected individuals than Egypt.

The top-ten regions in order of the percentage of their population which has CHC (prevalence) are

Sub-Saharan Africa, West; Sub-Saharan Africa, Central; Eastern Europe; Central Asia; North Africa/Middle East; “Other”; Latin America, Tropical; Central Europe; Australasia; and South Asia.

The top-ten regions in order of the total number of people with CHC (followed by the % prevalence) are:

  • South Asia (15.2 million, 0.9%);
  • Sub-Saharan Africa, West (14.9 million, 4.1%);
  • East Asia (10 million, 0.7%);
  • North Africa/Middle East (9.7 million, 2.1%);
  • Eastern Europe (4.7 million, 2.3%);
  • SE Asia (4.2 million, 0.7%);
  • North America (2.8 million, 0.8%);
  • Sub-Saharan Africa, Central (2.6 million, 2.6%);
  • Western Europe (2.6 million, 0.6%);
  • Sub-Saharan Africa, East (2.4 million, 0.6%)

NOTE: If we add together the three Sub-Saharan African regions above plus Sub-Saharan Africa South (0.7 million, 0.9%) the total, 20.6 million, puts Sub-Saharan Africa into the top position.

 

The genotypes are found in this distribution in the world:

  • Genotypes 1a and 1b = 46%;
  • Genotype 2 = 22%;
  • Genotype 3 = 13%;
  • Genotype 4 = 13%; and
  • Genotypes 5 and 6 together = 6%.

For maps, see link below.

Source: www.journal-of-hepatology.eu/article/S0168-8278(14)00526-1/pdf
Armed with this new data and the new DAA drugs, governments now have the weapons at hand to develop TARGETED testing and treatment campaigns aimed at eliminating hepatitis C from BC, from Canada, and the rest of the world. The time is ripe; let’s DO IT!