Prevalence and risk factors of hepatitis C virus infection in the rural northeastern United States

Nov. 24, 2021

Introduction and Objectives

The majority of studies regarding hepatitis C virus (HCV) prevention, screening, and treatment have been conducted in urban populations, and it is unlikely that their findings are broadly generalizable to nonurban populations. This study aimed to measure the prevalence and risk factors of HCV infection in the rural northeastern United States (US) to provide further clinical guidance for HCV screening.

Materials and methods

This was a retrospective review of all patients older than 18 years evaluated at an integrated healthcare system, serving northern Pennsylvania and southern and central New York, who received first-time HCV screening from January 2014 to December 2019.


30,549 patients were screened, of which 1.7% were HCV antibody positive. From 2014 to 2018, the incidence of positive HCV antibody screening cases per 100,000 population increased two-fold from 18.1 in 2014 to 40.4 in 2018. The age of positive HCV antibody patients peaked at 29.13 (95% CI 26.15-31.77) and 59.93 (95% CI 58.71-61.17). Positive HCV antibody was associated with positive urine drug screen (OR 5.9; 95% CI 3.8-9.3), narcotic use (OR 25.4; 95% CI 8.7-77.8), and overdose (OR 17.5; 95% CI 3.0-184.6).


In this rural northeastern US population, there is an increasing incidence of positive HCV screening with a bimodal age of distribution. Risk factors associated with opioid use reflect challenges to disease eradication in this population. We propose a one-time screening for persons aged 35 to 40 will aid in earlier HCV infection diagnosis and treatment in rural populations.

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