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Hepatitis C in People of Color: what to Know

Curated by Claudia Shannon / Research Scientist / ishonest

More than 2.5 million Americans live with hepatitis C, a liver infection caused by the virus of the same name. Although hepatitis C affects people of all races and ethnicities, certain groups are disproportionately affected by the virus and develop complications like liver cancer.

People of Color make up a disproportionately high share of hepatitis C diagnoses in the United States. According to the Office of Minority Health, while the rates of acute and chronic infection are lower in non-Hispanic Black people, the death rates are higher.

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No.373 - Blackheads

American Indian and Alaska Natives have a higher incidence rate of hepatitis C, along with the highest age-adjusted hepatitis C mortality rate among all other racial and ethnic groups.

Hispanic Americans get this virus at about the same rates as white Americans, but they have worse outcomes. They are more likely to have complications and to die from hepatitis C.

New antiviral treatments can cure hepatitis C and prevent complications like cirrhosis and liver cancer in most people who get them. But People of Color arent being offered treatments at the same rate as white people.

Read on to learn what we know about these disparities, along with what may help to address them.

How common is hepatitis C in People of Color?

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Hepatitis C is more than twice as common in non-Hispanic Black people as in non- Hispanic white people. About 23 percent of Americans with hepatitis C are Black, even though African Americans make up just 13 percent of the total population.

The highest rates of infection are among Black men in their 40s. The prevalence of hepatitis C in this group is almost 10 percent.

The rate of hepatitis C infections and deaths is also high in American Indians/ Alaskan Natives. People in this group are over three times more likely to be diagnosed with the virus than non-Hispanic white people.

Why are People of Color affected more?

So why do more People of Color develop the infection, and why do they have worse outcomes? There are a few possible reasons for the disparities.

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One reason is that People of Color are often not included in clinical trials testing the safety and effectiveness of new treatments. Only 13 percent of participants in hepatitis C trials in the United States are African American. Researchers can not learn whether new hepatitis C treatments work in People of Color without including them in clinical trials.

Another cause may be systemic problems in People of Color receiving treatment for other chronic conditions, such as diabetes. One study found that Black Americans were around 65 percent less likely to be deemed eligible for hepatitis C treatments than non-Black Americans.

While they found multiple contributing factors leading to this ineligibility, uncontrolled diabetes and renal insufficiency were factors more prevalent in the Black study participants. The researchers note that comprehensive strategies to provide effective medical care for these conditions could reduce or remove this barrier for Black Americans.

A lack of access to testing and treatments for hepatitis C is another reason.

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Black Americans who are at risk for hepatitis C are less likely to get tested than white people with the same risks. And African Americans who do test positive are less than half as likely as white Americans to be offered treatment or to receive it.

New hepatitis C treatments could help level the outcomes for People of Color, but only in those who get access to treatment. More than 90 percent of people from all races could be cured with direct-acting antiviral drugs. Still, many African Americans arent considered eligible for treatment.

Research indicates that there isnt clinical evidence to support the idea that African Americans should be considered less eligible for treatment. Instead, the reduced access is likely the result of racial discrimination.

There may also be geographical barriers to access. One 2021 study within an Alaska Native/American Indian community found that those in rural locations were more likely to experience challenges getting medication and resulting delays or gaps in treatment.

How are the outcomes different?

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No.165 - Uneven Skin Tone

About 30 percent of people who get an acute hepatitis C infection clear the virus on their own without any treatment within 6 months.

However, people who dont clear the virus develop chronic hepatitis C infection. Without treatment, theyre at higher risk for cirrhosis and other liver complications from the virus.

Even though Hispanic people have lower rates of hepatitis C than other groups, theyre more likely to have complications and die from the virus than white people. In 2016, the rate of hepatitis C-related deaths in Latinos was nearly 5.7 percent, compared to a national rate of less than 4.5 percent.

The Hispanic/Latino population has a diverse heritage. Some evidence suggests that a persons country of origin affects both their chances of getting hepatitis C and their outcome. For this reason, its important that more research is done to understand how country of birth, country of heritage, or other factors may impact hepatitis C risks and outcomes.

What can you do?

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Researchers can help to reduce disparities by including more People of Color in hepatitis C research studies.

Doctors can ensure that their patients of color get screened and treated if they test positive.

There are also things you can do to protect yourself. About half of people with hepatitis C dont know they have the infection. Getting screened with a blood test will let you know whether you have hepatitis C so that you can get started on treatment.

The Centers for Disease Control and Prevention recommends a one-time screening for all adults ages 18 and older and for pregnant people. Talk with your doctor about getting tested if you have risks like these:

  • You have HIV.
  • Youve injected drugs and shared needles or syringes.
  • Youve had a blood transfusion or organ transplant.
  • You work in healthcare and were accidentally stuck with a needle.
  • Youve ever received dialysis.

New direct-acting antiviral medications are very effective at curing hepatitis C. If you do test positive and your doctor doesnt recommend medication, ask for a second opinion to ensure that you get the treatment you need.

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