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Gender, Ethnicity, IDU, and Risk for HCV Among New York City Jail Inmates
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Reported by Jules Levin
IDSA 2015 Oct 7-11 San Diego, CA
Matthew Akiyama, MD, MSc1, Fatos Kaba, MA2, Zachary Rosner, MD2, Robert Holzman, MD3, and Ross Macdonald, MD2
1Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
2New York City Department of Health and Mental Hygiene, Bureau of Correctional Health Services, Queens, NY
3 New York University Langone Medical Center, New York, NY
Program Abstract:
Background:
Hepatitis C (HCV) is the leading cause cirrhosis, liver failure, and hepatocellular carcinoma in the US. Intravenous drug use (IDU) is a major risk factor. HCV in prison populations has reached alarming proportions estimated nationally to be approximately 17.4% due in part to the strong interrelationship between IDU and incarceration. Less data on prevalence is available for jails. The New York City jail system admits 70,000 annually with an average daily census of 12,000. In June 2013, screening of those born from 1945 to 1965 (the "birth cohort") was added to a program of targeted screening.
Methods: We reviewed all inmates having HCV antibody (HCVAb) tests obtained at jail intake between June 13th, 2013 (the date birth cohort screening was initiated) and June 13th, 2014. Factors examined included gender, ethnicity, and birth cohort membership. Proportions were compared using the Chi Square tests.
Results: There were 10,790 inmates with complete intake data in this time period who had positive or negative HCVAb tests - 2,221 (20.6%) were positive. A history of IDU was reported by 18.2% of the sample of whom 67.6% were HCVAb positive. Significantly more females reported IDU than males (21% vs. 16%, p<0.001) and were HCVAb positive (24% vs. 20%, p<0.001). Stratified by birth cohort, this relationship was maintained among all age groups (Figure 1).
Significant differences were also observed between ethnicities. Overall, non-Hispanic (NH) Whites had the highest prevalence of both IDU and HCV and NH Blacks had the lowest (p<0.001) (Figure 2). Stratified by birth cohort, IDU was more frequent in the older NH black population and younger NH White population conferring the same pattern of HCV risk.
Conclusion: These data reveal gender and ethnically based differences in the distribution of IDU and HCV infection in a large urban jail system. While a majority of those with HCV in the US are born between 1945-1965, HCV infection is not rare among younger inmates. Our data suggest that broader screening followed by a focused public health intervention is required in order treat existing infections and prevent future disease.
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