The proportion of baby boomers who have been tested for
hepatitis C in the United States since 2013 has increased only marginally
despite a US Centers for Disease Control and Prevention (CDC) recommendation that everyone born
between 1945 and 1965 should be tested for hepatitis C at least once,
researchers from Johns Hopkins University report in Clinical Infectious Diseases.
The CDC made its recommendation
to screen everyone in the 'baby boomer' generation because studies showed that three
out of four people with hepatitis C virus (HCV) in the United States fell into the baby boomer age
The prevalence of hepatitis C is higher in people born
between 1945 and 1965 because baby boomers were more likely to have come into
contact with infected blood through medical procedures as a result of
inadequate infection control. They were also more likely to have been exposed
to HCV through blood transfusions or blood products prior to the introduction
of screening in 1992. Baby boomers may also have been exposed to HCV through
injecting drug use.
Screening for hepatitis C is essential for diagnosis of
chronic HCV infection and access to curative treatment, and to achieve the World
Health Organization target of a 65% reduction in HCV-related mortality by 2030,
the US National Academies Science and Medicine Division has estimated that
between 70,000 and 110,000 cases of hepatitis C need to be diagnosed in the
United States every year until 2030.
The CDC 'birth cohort screening' recommendation received
publicity in national and local news media when it was issued in 2012. Johns
Hopkins University researchers investigated the impact of the recommendation on
hepatitis C testing rates in the US population, using the National Health
Interview Surveys between 2013 and 2017.
The National Health Interview Survey samples US households each year, aiming to reproduce the demographics of the US
population. The survey does not cover incarcerated or institutionalised
populations. The Survey asks, “Have you ever had a blood test for hepatitis C?”
A total of 120,539 people answered 'yes' or 'no' to the HCV
testing question in the Survey between 2013 and 2017. The size of the sample
declined from 2013 to 2017 but demographic variation from year to year was
minimal, with the exception that the proportion of people without health
insurance declined from 23% in 2013 to 13% in 2017 among people born after
1965, and from 13% to 6% in those born between 1945 and 1965.
HCV testing increased among both baby boomers and non-baby
boomers between 2013 and 2017 but the increases were modest.
Among those born between 1945 and 1965, testing coverage
increased from 12.3% in 2013 to 17.3% in 2017. Among those born between 1966
and 1994, testing coverage increased from 13.2% to 16.8%.
Testing coverage increased in all demographic groups apart
from Asians, Hispanic baby boomers and baby boomers born outside the United States
and did not increase in uninsured people.
However, by 2017, testing coverage among baby boomers was significantly
lower in women and persons who did not complete high school, and in baby
boomers living in the South or Midwest states.
Despite a recommendation of universal testing for the baby
boomer generation, the analysis shows that “the majority of the US household
population has not been tested for HCV infection,” the authors conclude. They
highlight the lower probability of testing for hepatitis C in the South and
Midwest, and lack of health insurance, as important systemic barriers to
increasing testing coverage. They also stress the importance of improving HCV
screening outside primary health care in settings such as emergency rooms,
nursing homes and methadone programmes.