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The Rhode Island Department of Health (RIDOH) and the Rhode Island Public Health Institute (RIPHI) announced Thursday in a new report that there has been a significant increase in Hepatitis C virus-related hospitalizations and deaths in Rhode Island.
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Download the PDF here
Rhode Island health officials report a significant increase in hospitalizations and deaths during the last decade related to the hepatitis C virus, and are urging baby boomers and others in high-risk groups to be tested.
For the first time, Rhode Island has one of the most complete pictures of the extent of the hepatitis C epidemic. More people are infected, and more are dying from the viral disease than previously known.
There were significant increases in HCV-related deaths in Rhode Island in recent years.
Some key findings of the report include that Hepatitis C-related deaths rose from 25 in 2005 to 102 in 2014, based on death certificate data, which may underreport hepatitis C-related deaths.
The number of inpatient hospitalizations with a primary discharge diagnosis of Hepatitis C increased six-fold between 2005 and 2014.
Authorities at The Rhode Island Department of Corrections (RIDOC) say that there has been an increased effort in the areas of screening and treatment since 2013.
Safe, highly effective Hepatitis C medications are now available. These medications create an opportunity to reduce rates of Hepatitis C and, cure the virus in a few weeks or months.
"The rise in Hepatitis C-related death rates is alarming. However, the good news is, we have medications that can cure people living with Hepatitis C," said Director of RIPHI Dr. Amy Nunn.
"The first step in curing Rhode Islanders of Hepatitis C is screening. Both Baby Boomers and anyone who is at high risk, such as people who have used injection drugs or people who received blood transfusions prior to 1992, should ask their physicians to screen them for Hepatitis C. People should then seek evaluation and treatment if they have Hepatitis C."
From 2005 to 2014, people ages 45 to 64 accounted for nearly two-thirds (64.8%) of HCV-related hospitalizations in Rhode Island (Figure 4).
From 2005 to 2014, the number of hospitalizations at Rhode Island acute-care hospitals ranged from 112,715 to 132,455 hospitalizations per year.
Patients in the United States with chronic HCV are estimated to have a hospitalization rate three times that of people without HCV infection.13 As the HCV-infected population ages, people living with untreated HCV can develop cirrhosis, liver cancer, and liver failure.
In Figure 2, shows a similar trend in Rhode Island for HCV-related hospitalizations, this data focusing on any discharge diagnosis. Discharge diagnosis of HCV remained consistently higher than HIV and HBV hospitalizations combined during the past decade, and increased slightly in recent years.
Nationally, deaths attributed to HCV have surpassed the total number of deaths attributed to HIV and 59 other infectious diseases, combined, in recent years.4 In Figure 2, shows a similar trend in Rhode Island for HCV-related hospitalizations, this data focusing on any discharge diagnosis. Discharge diagnosis of HCV remained consistently higher than HIV and HBV hospitalizations combined during the past decade, and increased slightly in recent years.
There is an overwhelming public health opportunity associated with screening and curing HCV; new medications can cure most individuals living with HCV in eight to 12 weeks and dramatically reduce HCV-related morbidity. HCV screening has increased significantly in Rhode Island in recent years, both in clinical and non-clinical settings.
RI Medicaid also reported large volumes of HCV screening. Medicaid claims data suggest that approximately 13,000 Medicaid beneficiaries underwent HCV antibody screening in 2014 and in 2015. More than 1,700 HCV genotype test claims were made to Medicaid in 2014-2015, suggesting that there were approximately 1,700 Medicaid beneficiaries with an HCV diagnosis in Rhode Island in 2014 and 2015. It is unknown how many of those individuals sought curative treatment and care services, but RI Medicaid financed HCV treatment for 215 Medicaid beneficiaries in 2015.
Treating HCV is cost effective because in the long run, it reduces future HCV-morbidity and saves the lives of people living with HCV.
This is the first comprehensive epidemiologic report from diverse data sources regarding hepatitis C virus (HCV) for the state of Rhode Island.
The HCV prevalence rate, based on antibody testing from health systems and laboratories represented in this report ranged from 3.7% to 6%. The percentage of individuals with confirmed chronic HCV who underwent antibody screening is previously unknown; however, based on national estimates, this would likely range from 3.1% to 5.1%. .....Previous studies estimated that nearly 23,000 individuals in Rhode Island (approximately 2% of Rhode Islanders) are currently chronically infected with HCV.5
Chronic HCV infection causes hepatic fibrosis, cirrhosis, liver cancer, and liver failure, and is the most common reason for needing a liver transplant. Nationwide, more people die of HCV-related causes than from HIV and 59 other infectious diseases combined.4
Previous studies estimated that nearly 23,000 individuals in Rhode Island (approximately 2% of Rhode Islanders) are currently chronically infected with HCV.5
A comprehensive set of action steps are needed to address the HCV disease burden in Rhode Island.
The Rhode Island Public Health Institute, in partnership with the Rhode Island Department of Health and the state's leading HCV care providers, joined with key stakeholders to develop the Rhode Island Hepatitis C Action Coalition (RIHAC) in 2014. RIHAC's primary goal is to reduce the HCV disease burden in Rhode Island and to advance HCV screening, confirmatory testing, treatment, and cure. The coalition is comprised of more than 75 stakeholders, including clinicians, advocates, public health officials, community-based agencies, researchers, and public servants. Most of the providers who treat large volumes of HCV patients participate in RIHAC. RIHAC also leads efforts to enhance and scale HCV screening and treatment in the state of Rhode Island through advocacy and education, capacity building, and provider training. RIHAC has helped inform Rhode Island's forthcoming strategic plan for HCV.
Supported by an Innovation Fellowship from the Rhode Island Foundation to Lynn E. Taylor, MD, RI Defeats Hep C is a comprehensive program to "Seek, Treat, Cure and Eliminate HCV" in the state. RID Hep C also aims to reduce illness, suffering, and deaths due to HCV in Rhode Island; save money for the state and Rhode Islanders by enhancing proactive HCV care; and bring resources into the state to help combat the HCV epidemic. RID Hep C focuses on the key target populations of baby boomers (anyone born between 1945 and 1965) and people with a history of injection drug use. Recent accomplishments include development of the aforementioned estimates on prevalence of HCV in Rhode Island,5 and an effort to eliminate HCV at CODAC (RI's only not-for-profit methadone clinic).
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