County-Level Variation in Hepatitis C Virus Mortality and Trends in the United States, 2005-2017.


Since 2013, the national HCV death rate has steadily declined, but this decline has not been quantified or described on a local level. We estimated county-level HCV death rates and assessed trends in HCV mortality from 2005 to 2013 and 2013 to 2017. We used mortality data from National Vital Statistics Systems and a Bayesian multivariate space-time conditional autoregressive model to estimate age-standardized HCV death rates from 2005 through 2017 for 3115 U.S. counties. Additionally, we estimated county-level age-standardized rates for persons <40 and 40+ years of age. We used log-linear regression models to estimate average annual percent change in HCV mortality during periods of interest and compared county-level trends to national trends. Nationally, the age-adjusted HCV death rate peaked in 2013 at 5.20 HCV deaths per 100,000 (95% credible interval, CI: 5.12, 5.26) before decreasing to 4.34 per 100,000 persons (95% CI: 4.28, 4.41) in 2017 (average annual percent change -4.69, 95%CI: -5.01, -4.33). County-level rates revealed heterogeneity in HCV mortality (2017 median rate=3.66, interdecile range: 2.19, 6.77), with the highest rates concentrated in the West, Southwest, Appalachia and northern Florida. Between 2013 and 2017, HCV mortality decreased in 80.0% (n=2274) of all U.S. counties with a reliable trend estimate, with 25.8% (n=803) of all counties experiencing a decrease larger than the national decline. Conclusion: Although many counties have experienced a shift in HCV mortality trends since 2013, the magnitude and composition of that shift have varied by place. These data provide a better understanding of geographic differences in HCV mortality and can be used by local jurisdictions to evaluate HCV mortality in their areas relative to surrounding areas and the nation.

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Hall EW, Schillie S, Vaughan AS, Jones J, Bradley H, Lopman B, Rosenberg E, Sullivan P. (2021). County-Level Variation in Hepatitis C Virus Mortality and Trends in the United States, 2005-2017. Hepatology (Baltimore, Md.)