Little progress towards 'test all baby boomers for hepatitis C' since 2013, US study shows

Keith Alcorn
Published:
17 September 2018

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 group.

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.

Reference

Patel EU et al. Limited coverage of hepatitis C virus testing in the United States, 2013-2017. Clinical Infectious Diseases, advance online publication, September 2018.