Reduce reported rate of hepatitis C-related deaths among American Indian and Alaska Native persons by 30% or more

Summary of Findings

Compared to the overall population, American Indian and Alaska Native (AI/AN) persons had a much higher age-adjusted hepatitis C-related mortality rate in 2020 (3.45 vs. 10.17 per 100,000, respectively). Although the mortality rate among AI/AN persons decreased slightly from 10.24 per 100,000 population in the 2017 baseline year, the rate of 10.17 in 2020 remains above the target rate of 8.71. The increase in age-adjusted hepatitis C-related mortality observed during 2020 may have been affected by the overall increase in US mortality during 2020 due to the COVID-19 pandemic; therefore, 2020 data should be interpreted with caution.

Reduction needed to meet 2025 goal:

A 29% reduction from the 2020 rate of hepatitis C-related deaths among AI/AN persons is needed to meet the 2025 goal of 7.17 deaths per 100,000 population.

This reduction can best be achieved by:

• Increasing access to hepatitis C testing for AI/AN persons.
• Increasing access to care and appropriate treatment for AI/AN persons.
• Developing trainings, technical assistance, and tools for primary-care and other health care providers to support implementation of hepatitis C testing and referral, specifically for AI/AN patients.
• Using digital technology and telemedicine models to expand access to specialty health care providers to all populations, including AI/AN persons.
• Implementing continuing education and educational campaigns to encourage testing and dispel myths about who is at increased risk for hepatitis C virus infection.

Technical Notes

Data Sources:
CDC, National Vital Statistics System (NVSS)

Numerator:
Number of death records among non-Hispanic AI/AN persons with a report of hepatitis C listed as the underlying or one of the multiple causes of death

Denominator:
Total US Census population of non-Hispanic AI/AN persons

Indicator Notes:
(1) Death certificates are completed for all deaths registered in the United States. Information for death certificates is provided to funeral directors or cremation organizations by attending physicians, medical examiners, and coroners. Death certificates are filed in vital statistics offices within each state and the District of Columbia. Through the NVSS, information from death certificates is compiled by CDC to produce national multiple-cause-of-death data; causes of death are coded in accordance with the International Classification of Diseases, Tenth Revision. (2) National multiple-cause mortality data from NVSS were obtained and analyzed, and those death records with a report of hepatitis C (ICD-10: B17.1 or B18.2) listed as the underlying or one of the multiple (i.e., contributing) causes of death in the record were enumerated. Rates were calculated as the number of deaths among AI/AN persons who were US residents in the 50 states and District of Columbia related to hepatitis C divided by the total US Census population of AI/AN persons in these jurisdictions using the bridged-race postcensal estimates of the July 1 resident population. Rates were standardized to the age distribution of the 2000 US Standard Population.

Goal Setting:
The 2025 goal of 7.17 hepatitis C-related deaths among AI/AN persons per 100,000 population is consistent with CDC’s Division of Viral Hepatitis 2025 Strategic Plan and HHS’s 2021-2025 Viral Hepatitis National Strategic Plan. Annual targets assume a constant (linear) rate of change from the observed baseline (2017 data year) to the 2025 goal (2023 data year).

Limitations:
Mortality data must be interpreted with caution due to the potential for misclassification of ICD-10 codes on the death record, underrepresentation of certain racial/ethnic populations in US Census data and underreporting of viral hepatitis as a cause of death on death certificates.