Determinants of confirmatory diagnosis of chronic hepatitis C among women of reproductive age: a surveillance-based analysis, 2018-2022

Tolu Arowolo; Mian Hossain; Comfort Adebayo; Ian Lindong; Abiola Oyesile; Adeola Animasahun

doi:10.18203/2394-6040.ijcmph20263581

Authors

Tolu Arowolo Department of Biology, Notre Dame Maryland University, Baltimore, Maryland, USA
Mian Hossain School of Community Health and Policy, Morgan State University, Baltimore, Maryland, USA
Comfort Adebayo Department of Communication Studies, Towson University, Baltimore, Maryland, USA
Ian Lindong School of Community Health and Policy, Morgan State University, Baltimore, Maryland, USA
Abiola Oyesile Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
Adeola Animasahun Department of Biology, Morgan State University, MD, USA

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20263581

Keywords:

Hepatitis C virus, Women of reproductive age, Confirmatory diagnosis, Surveillance, Health disparities, Maryland, Logistic regression

Abstract

Background: Women of reproductive age are disproportionately affected by chronic hepatitis C virus (HCV) infection, yet disparities in confirmatory diagnosis remain poorly understood. This study examined determinants of confirmed chronic HCV diagnosis among women aged 15-45 years in Maryland and assessed whether rural or urban residence influenced diagnostic confirmation.

Methods: This cross-sectional study used secondary surveillance data from the Maryland National Electronic Disease Surveillance System (NEDSS) for women aged 15-45 years with chronic HCV reported between 2018 and 2022. We used logistic regression to assess the association between residence and confirmed diagnosis, controlling for demographic characteristics and period of diagnosis.

Results: Among 2,197 women, 62.7% had a confirmed diagnosis and 37.3% were classified as probable cases. Bivariate analyses showed significant associations between diagnosis status and residence, age, and race. In unadjusted analysis, rural residents were more likely than urban residents to receive a confirmed diagnosis (OR=1.30, 95% CI: 1.09-1.54). After adjustment, residence was no longer significant (OR=1.07, 95% CI: 0.89-1.29). Women aged 26-35 years had higher odds of confirmed diagnosis than those aged 15-25 years (OR=1.32, 95% CI: 1.03-1.70). Compared with White women, Black women (OR=0.45, 95% CI: 0.35-0.58) and women of other racial backgrounds (OR=0.51, 95% CI: 0.26-0.99) had lower odds of confirmation.

Conclusions: Age and race were stronger determinants than residence, highlighting persistent disparities in completion of HCV diagnostic evaluation and the need for targeted confirmatory testing efforts.

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References

Choo QL, Kuo G, Weiner AJ, Overby LR, Bradley DW, Houghton M. Isolation of a cDNA clone derived from a blood-borne non-A, non-B viral hepatitis genome. Science. 1989;244(4902):359-62. DOI: https://doi.org/10.1126/science.2523562

Centers for Disease Control and Prevention. 2023. Signs and Symptoms of Hepatitis C. Available at: htttps://www.cdc.gov/hepatitis-c/Signs-Symptoms/Index.html. Accessed on 20 June 2026.

Rossi C, Butt ZA, Wong S, Buxton JA, Islam N, Yu A, et al. Hepatitis C virus reinfection after successful treatment with direct-acting antiviral therapy in a large population-based cohort. J Hepatol. 2018;69(5):1007-14. DOI: https://doi.org/10.1016/j.jhep.2018.07.025

Konerman MA, Thomson M, Gray K, Moore M, Choxi H, Seif E, et al. Impact of an electronic health record alert in primary care on increasing hepatitis C screening and curative treatment for baby boomers. Hepatology. 2017;66(6):1805-13. DOI: https://doi.org/10.1002/hep.29362

Hofmeister MG, Rosenthal EM, Barker LK, Rosenberg ES, Barranco MA, Hall EW, et al. Estimating Prevalence of Hepatitis C Virus Infection in the United States, 2013-2016. Hepatology. 2019;69(3):1020-31. DOI: https://doi.org/10.1002/hep.30297

Zibbell JE, Asher AK, Patel RC, Kupronis B, Iqbal K, Ward JW, Holtzman D. Increases in Acute Hepatitis C Virus Infection Related to a Growing Opioid Epidemic and Associated Injection Drug Use, United States, 2004 to 2014. Am J Public Health. 2018;108(2):175-81. DOI: https://doi.org/10.2105/AJPH.2017.304132

Ely DM, Gregory ECW. Trends and Characteristics in Maternal Hepatitis C Virus Infection Rates During Pregnancy: United States, 2016-2021. National Vital Statistics Rep. 2023;72(3):1-12. DOI: https://doi.org/10.15620/cdc:124659

Oliver C, Black J, De Pont S, Sizemore L, Wester C. Pregnancy Status, Risk Factors, and Opportunities for Referral to Care Among Reproductive-Aged Women with Newly Reported Chronic Hepatitis C Virus Infection in Tennessee. Public Health Rep. 2020;135(1):90-6. DOI: https://doi.org/10.1177/0033354919887742

Hughes BL, Page CM, Kuller JA. Hepatitis C in pregnancy: screening, treatment, and management. Am J Obstet Gynecol. 2017;217(5):B-2-12. DOI: https://doi.org/10.1016/j.ajog.2017.07.039

Kushner T, Terrault NA. Hepatitis C in Pregnancy: A Unique Opportunity to Improve the Hepatitis C Cascade of Care. Hepatol Communications. 2019;3(1):20-8. DOI: https://doi.org/10.1002/hep4.1282

Centers for Disease Control and Prevention. 2021. Hepatitis C, Perinatal Infection 2018 Case Definition. Available at: Https://ndc.services.cdc.gov/Case-Definitions/Hepatitis-c-Perinatal-Infection-2018/. Accessed on 20 June 2026.

Centers for Disease Control and Prevention. (2021a). Hepatitis C, Chronic 2016 Case Definition. Available at: https://ndc.services.cdc.Gov/Case-Definitions/Hepatitis-c-Chronic-2016/. Accessed on 20 June 2026.

Falade-Nwulia O, Kelly SM, Amanor-Boadu S, Nnodum BN, Lim JK, Sulkowski M. Hepatitis C in Black Individuals in the US. JAMA. 2023;330(22):2200. DOI: https://doi.org/10.1001/jama.2023.21981

Marcus JL, Hurley LB, Chamberland S, Champsi J H, Gittleman LC, Korn DG, et al. Disparities in initiation of direct-acting antiviral agents for hepatitis c virus infection in an insured population. Public Health Rep. 2018;133(4):452-60. DOI: https://doi.org/10.1177/0033354918772059

Walters SM, Frank D, Felsher M, Jaiswal J, Fletcher S, Bennett AS, et al. How the rural risk environment underpins hepatitis C risk: Qualitative findings from rural southern Illinois, United States. Int J Drug Policy. 2023;112:103930. DOI: https://doi.org/10.1016/j.drugpo.2022.103930

Gonzalez Corro LA, Zook K, Landry M, Rosecrans A, Harris R, Gaskin D, et al. An Analysis of Social Determinants of Health and Their Implications for Hepatitis C Virus Treatment in People Who Inject Drugs: The Case of Baltimore. Open Forum Infectious Dis. 2024;11(4):ofae107. DOI: https://doi.org/10.1093/ofid/ofae107

Alenzi M, Almeqdadi M. Bridging the gap: addressing disparities in hepatitis C screening, access to care, and treatment outcomes. World J Hepatol. 2024;16(8):1091. DOI: https://doi.org/10.4254/wjh.v16.i8.1091

Holtzman D, Asher AK, Schillie S. The Changing Epidemiology of Hepatitis C Virus Infection in the United States During the Years 2010 to 2018. Am J Public Health. 2021;111(5):949-52. DOI: https://doi.org/10.2105/AJPH.2020.306149

Schranz AJ, Barrett J, Hurt CB, Malvestutto C, Miller WC. Challenges Facing a Rural Opioid Epidemic: Treatment and Prevention of HIV and Hepatitis C. Current HIV/AIDS Rep. 2018;15(3):245-54. DOI: https://doi.org/10.1007/s11904-018-0393-0

Gordon SC. Hepatitis C virus detection and treatment in rural communities. Gastroenterol Hepatol. 2018;14(12):720-22.

Westergaard RP, Stockman LJ, Hyland HA, Guilfoyle SM, Fangman JJ, Vergeront JM. Provider Workforce Assessment in a Rural Hepatitis C Epidemic. J Primary Care Community Health, 2015;6(3):215-7. DOI: https://doi.org/10.1177/2150131914560229

Lewis KC, Barker LK, Jiles RB, Gupta N. Estimated Prevalence and Awareness of Hepatitis C Virus Infection Among US Adults: National Health and Nutrition Examination Survey, January 2017-March 2020. Clin Infect Dis. 2023;77(10):1413-15. DOI: https://doi.org/10.1093/cid/ciad411

Centers for Disease Control and Prevention. 2024. 2022 Viral Hepatitis Surveillance Report. Available at: Https://ndc.services.cdc.gov/Case-Definitions/Hepatitis-c-Chronic-2016/. Accessed on 20 June 2026.

Owens DK, Davidson KW, Krist AH, Barry MJ, Cabana M, Caughey AB, et al. Screening for Hepatitis C Virus Infection in Adolescents and Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2020;323(10):970-5. DOI: https://doi.org/10.1001/jama.2020.1123

Chung RT, Ghany MG, Kim AY, Marks KM, Naggie S, Vargas HE, et al. Hepatitis C guidance 2018 update: aasld-idsa recommendations for testing, managing, and treating Hepatitis C Virus infection. Clin Infect Dis. 2018;67(10):1477-92. DOI: https://doi.org/10.1093/cid/ciy585

Maryland Department of Health. 2021. Maryland Viral Hepatitis Epidemiological Profile. Available at: https://Health.Maryland.gov/phpa/OIDPCS/AVHPP/Documents/Maryland_ViralHepatitis_EpiProfile_final_July.28.2021.Pdf. Accessed on 20 June 2026.

World Health Organization. 2024. Elimination of Hepatitis by 2030. Available at: https://www.who.int/health-topics/hepatitis/ elimination-of-hepatitis-by-2030#tab=tab_1. Accessed on 20 June 2026.