Portland Area Health Priorities
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1 Portland Area Indian Health Service Portland Area Health Priorities CAPT Thomas Weiser, MD, MPH Medical Epidemiologist Portland Area Budget Formulation Meeting Portland, November 30, 2017
2 Overview Brief History of Hepatitis C Hepatitis C Liver Disease Leading Causes of Death (Mortality) Hepatitis C Liver Disease Leading Causes of Hospitalization (Morbidity) Hepatitis C Liver Disease Years of Potential Life Lost (YPLL)
3 Brief History of Hepatitis C Mortality, Morbidity and Years of Potential Life Lost
4 Brief History of Hepatitis C 1975: A virus capable of causing hepatitis that was not hepatitis A or hepatitis B was discovered ( non-a, non-b hepatitis ) 1989: The non-a, non-b hepatitis virus is isolated: hepatitis C virus 1990: Testing of US blood supply for Hepatitis C 1991: First treatment regimen developed, interferon alfa 2b 1992: Improved sensitivity test adopted for US blood supply 1998: Ribavirin plus interferon treatment 2001: Pegylated interferon
5 Brief History of Hepatitis C 2010: Rapid antibody test developed 2013: First direct-acting antiviral (DAA) medications allows treatment without interferon 2015-present: New DAAs with increased rates of cure for most genotypes, with fewer doses and shorter treatment durations for many patients
6 Natural History of Hepatitis C 15%-25% of HCV infections will resolve without treatment depending on age, sex, race, severity of initial infection, immune status and host genotype Copyright 2018 Hepatitis C Online - AWS
7 Global Distribution of HCV Estimated and reported HCV viremic disease Highest in West Africa, Egypt, Russia, and parts of Central Asia and Eastern Europe Data quality is poor in many of these areas Absolute numbers of people infected are highest in China, India, Nigeria, Egypt, US, Brazil, Russia J Hepatology Volume 61(1), Supp, 2014 (Nov): S45-S57
8 Total global viremic HCV infections Estimated at 80 (64 103) million infections. Genotype distribution: genotype 1 (G1) (46%) G3 (22%) G2 (13%) G4 (13%) J Hepatology Volume 61(1), Supp, 2014 (Nov): S45-S57
9 Impact Measures Mortality, Morbidity and Years of Potential Life Lost for AI/AN in the Western Region and NW States
10
11 Top 10 Causes of Death, Men American Indian/Alaska Native Western Region, Data Source: National Center for Health Statistics (NCHS) Vital Statistics System.
12 Top 10 Causes of Death, Women American Indian/Alaska Native Western Region, Data Source: National Center for Health Statistics (NCHS) Vital Statistics System.
13 Leading Causes of AI/AN Hospitalization, Washington, 2011 Males < 1 Year Overall Perinatal Respiratory Injury & Poisoning Injury & Poisoning Circulatory Circulatory Perinatal Respiratory Injury & Poisoning Digestive Digestive Digestive Respiratory Digestive Congenital Anomalies Digestive Endocrine/Immun. Skin & Soft Tissue Injury & Poisoning Digestive Injury & Poisoning Perinatal Pregnancy & Childbirth Females Pregnancy & Childbirth Digestive Circulatory Pregnancy & Childbirth Respiratory Injury & Poisoning Digestive Digestive Respiratory Respiratory Digestive Respiratory Congenital Anomalies Digestive Injury & Poisoning Injury & Poisoning Circulatory Digestive Perinatal Produced by: Northwest Portland Area Indian Health Board Improving Data & Enhancing Access - Northwest (IDEA-NW) Project Data Source: Washington Comprehensive Hospital Abstract Reporting System (CHARS) 2011
14 Leading Causes of AI/AN Hospitalization, Oregon, 2011 Males < 1 Year Overall Perinatal Respiratory Injury & Poisoning Digestive Circulatory Circulatory Perinatal Respiratory Digestive Mental Illness Mental Illness Digestive Respiratory Circulatory Congenital Injury & Anomalies Poisoning Digestive Injury & Poisoning Injury & Poisoning Musculoskeletal Digestive Perinatal Respiratory Pregnancy & Childbirth Females Pregnancy & Childbirth Digestive Circulatory Pregnancy & Childbirth Respiratory Digestive Digestive Genitourinary Musculoskeletal Respiratory Perinatal Congenital Injury & Anomalies Poisoning Mental Illness Digestive Circulatory Digestive Digestive Produced by: Northwest Portland Area Indian Health Board Improving Data & Enhancing Access - Northwest (IDEA-NW) Project Data Source: Oregon Association of Hospitals & Health Systems,
15 Years of Potential Life Lost, American Indian/Alaska Native, West Region Years of Potential Life Lost, Women Years of Potential Life Lost, Men Unintentional Injury Liver Disease Malignant Neoplasms Heart Disease Suicide Diabetes Mellitus Congenital Anomalies Perinatal Period Homicide Cerebrovascular Unintentional Injury Suicide Heart Disease Liver Disease Malignant Neoplasms Homicide Diabetes Mellitus Perinatal Period Congenital Anomalies Influenza & Pneumonia Data Source: National Center for Health Statistics (NCHS) Vital Statistics System.
16 HCV-Specific Data
17 Rate per 100,000 population Age-adjusted Hepatitis C-related Mortality Northwest, Rate Ratio (95% Confidence Interval) AI/AN : NHW 0 AI/AN NHW AI/AN NHW AI/AN NHW AI/AN NHW Northwest Overall Idaho Oregon Washington 3.33 (2.96, 3.75) 3.22 (1.85, 5.62) 2.52 (2.04, 3.11) 3.88 (3.34, 4.50)
18 Rate per 100,000 Age-Adjusted HCV-Related Mortality, AI/AN NHW
19 Analysis of IHS HCV Diagnoses, Journal of Community Health, May 28,
20 Analysis of IHS HCV Diagnoses, Journal of Community Health, May 28,
21 Conclusion Hepatitis C has a large impact on AI/AN populations as a cause of mortality and as an important contributor to high rates of hospitalization and years of potential life lost from liver disease. The mortality disparity, approximately 3.3 times that of non-hispanic whites likely reflects a number of disparities such as higher risks of exposure, earlier age of exposure, less access to testing and less access to treatment. The ongoing epidemic of injection opioid and meth use is an important contributor to increased risk of acute hepatitis C infection.
22 Thank You
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