Abstract
BackgroundImmigrants originating from intermediate and high HCV prevalence countries may be at increased risk of exposure to hepatitis C infection (HCV) in their countries of origin, however they are not routinely screened after arrival in most low HCV prevalence host countries. We aimed to describe the epidemiology of HCV in immigrants compared to the Canadian born population.MethodsUsing the reportable infectious disease database linked to the landed immigration database and several provincial administrative databases, we assembled a cohort of all reported cases of HCV in Quebec, Canada (1998–2008). Underlying co-morbidities were identified in the health services databases. Stratum specific rates of reported cases/100,000, rate ratios (RRs) and trends over the study period were estimated.ResultsA total of 20,862 patients with HCV were identified, among whom 1922 (9.2%) were immigrants. Immigrants were older and diagnosed a mean of 9.8 ± 7 years after arrival. The Canadian born population was more likely to have behavior co-morbidities (problematic alcohol or drug use) and HIV co-infection. Immigrants from Sub-Saharan Africa, Asia and Eastern Europe had the highest HCV reported rates with RRs compared to non-immigrants ranging from 1.5 to 1.7. The age and sex adjusted rates decreased by 4.9% per year in non-immigrants but remained unchanged in immigrants. The proportion of HCV occurring in immigrants doubled over the study period from 5 to 11%.ConclusionsImmigrants from intermediate and high HCV prevalence countries are at increased risk for HCV and had a mean delay in diagnosis of almost 10 years after arrival suggesting that they may benefit from targeted HCV screening and earlier linkage to care.
Highlights
Immigrants originating from intermediate and high Hepatitis C virus (HCV) prevalence countries may be at increased risk of exposure to hepatitis C infection (HCV) in their countries of origin, they are not routinely screened after arrival in most low HCV prevalence host countries
Health care utilization, costs and mortality due to hepatitis C infection are increasing in many low HCV prevalence countries in North America and Europe resulting in an enormous burden on society and health care systems [1,2,3,4,5,6,7,8]
Immigrants living in low HCV prevalence countries are a large underappreciated group that are disproportionately affected by HCV infection
Summary
Immigrants originating from intermediate and high HCV prevalence countries may be at increased risk of exposure to hepatitis C infection (HCV) in their countries of origin, they are not routinely screened after arrival in most low HCV prevalence host countries. Many immigrants from intermediate/high HCV prevalence countries will be missed in current risk factor based screening programs. In a population-based cohort, we aimed to determine the rates of newly reported HCV cases, the trend over time, and behavioral risk factors for exposure to HCV in immigrants as compared to the Canadian born population. The objective of this study was to identify immigrant groups who would benefit most from targeted HCV screening and early linkage to care. These data may be used to inform policy making and health care planning
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