1 2014 Hepatitis B and C Surveillance Report Viral Hepatitis Surveillance and Prevention Unit 1 | P a g e Table of Contents l Viral Hepatitis Data Summary ……………………………………………………………………………………….………………….………….………... 4 Table 1.1 Summary of Demographic Information by Type of Hepatitis, Michigan, 2014.…………..…..……………….…. 4 Executive Summary………………………………………………………………………………………………………………….…………….………..… 6 Background and Technical Notes………………………………………………………………………………………….…………………..……….….. 8 Michigan Census Data ……………………………………………………………………………………………………………………………………..…… 13 Figure 1.2 Age and sex: Michigan, 2010 ……………………………………………………………………….…………………………………… 14 Figure 1.3 Level of education: Michigan and the U.S., 2009-2013 …………………….………………………………………………. 14 Figure 1.4 Race and ethnicity: Michigan and the U.S., 2010 …………………………….……………….…………….……….……….. 15 Table 1.4 Population by race: Michigan, 2000-2010 ……………………………………………….………………….……………………… 15 Figure 1.5 Population under the poverty line by race: Michigan, 2009-2013 ………………………………….…………………. 16 Figure 1.6 Health insurance coverage, Michigan and the U.S., 2013 …………………………………………………….…………… 16 Figure 1.7 Income: Michigan and the U.S., 2013 …………………………………………………………………………….…………………. 16 Acute Hepatitis B Data Summary ……………………………………………………………………………………………………………………….… 17 Table 2.1: Incidence of Acute Hepatitis B, Michigan and U.S., 2004-2014 ………………………………………..……………… 18 Figure 2.1: Incidence of Acute Hepatitis B, Michigan and U.S., 2004-2014 …………………………..………………………….. 18 Table 2.2: Incidence of Acute Hepatitis B by Gender, Michigan, 2004-2014 ………………………………..………………….. 19 Figure 2.2: Incidence of Acute Hepatitis B by Gender, Michigan, 2004-2014 ………………………………..…………………. 19 Table 2.3: Incidence of Acute Hepatitis B by Race and Ethnicity, Michigan, 2004-2014 …………………..…………...…. 20 Figure 2.3: Incidence of Acute Hepatitis B by Race and Ethnicity, Michigan, 2004-2014 …………………..……………… 20 Table 2.4a: Completeness of Acute Hepatitis B Reports by Risk Behavior, Michigan, 201 ………………..…………….. 21 Table 2.4b: Response of Completed Acute Hepatitis B Reports by Risk Behavior, Michigan, 2014 ………..…………. 21 Chronic Hepatitis B Data Summary…………………………………………………………………………………………………………….…………. 22 Figure 3.1: Chronic Hepatitis B Cases per 100,000 Population, Michigan, 2004-2014……………………………..….…….. 23 Table 3.1: Chronic Hepatitis B Cases per 100,000 Population by Gender, Michigan, 2004-2014……………………….. 23 Figure 3.2: Chronic Hepatitis B Cases per 100,000 Population by Gender, Michigan, 2004-2014…………………..…. 24 Table 3.2: Chronic Hepatitis B Cases per 100,000 Population by Race and Ethnicity, Michigan, 2004-2014…..…. 24 Table 3.3 Chronic Hepatitis B Cases per 100,000 by Race and Ethnicity, Michigan, 2004-2014 ………………………… 25 Figure 3.3: Chronic Hepatitis B Cases per 100,000 Population by Race and Ethnicity, Michigan, 2004-2014…..… 25 Acute Hepatitis C Data Summary………………………………………………………………………………………………………………………….. 26 Table 4.1: Incidence of Acute Hepatitis C, Michigan and U.S., 2004-2014………………………………………………………... 27 Figure 4.1: Incidence of Acute Hepatitis C, Michigan and U.S., 2004-2014……………………………………………………..… 27 Table 4.2: Incidence of Acute Hepatitis C by Gender, Michigan, 2004-2014…………………………………………………..…. 28 Figure 4.2: Incidence of Acute Hepatitis C by Gender, Michigan, 2004-2014………………………………………………….... 28 Table 4.3: Incidence of Acute Hepatitis C by Race and Ethnicity, Michigan, 2004-2014……………………………………. 29 Figure 4.3: Incidence of Acute Hepatitis C by Race and Ethnicity, Michigan, 2004-2014…………………………………... 29 Table 4.4a: Completeness of Acute Hepatitis C Reports by Risk Behavior, Michigan, 2014………………….…………... 30 Table 4.4b: Response of Completed Acute Hepatitis C Reports by Risk Behavior, Michigan, 2014……………………. 30 Chronic Hepatitis C Data Summary……………………………………………………………………………………………………………………….. 31 Figure 5.1: Chronic Hepatitis B Cases per 100,000 Population, Michigan, 2004-2014……………………………………..… 32 Figure 5.1 Chronic Hepatitis C Cases per 100,000 Population, Michigan, 2004-2014 …………………………………….…. 32 Table 5.2: Chronic Hepatitis B Cases per 100,000 Population by Gender, Michigan, 2004-2014……………………….. 33 Figure 5.2: Chronic Hepatitis B Cases per 100,000 Population by Gender, Michigan, 2004-2014……………………... 33 Table 5.3: Chronic Hepatitis B Cases per 100,000 Population by Race and Ethnicity, Michigan, 2004-2014…..…. 34 Figure 5.3: Chronic Hepatitis C Cases per 100,000 Population by Race and Ethnicity, Michigan, 2004-2014…..… 34 Table 5.4a: Completeness of Chronic Hepatitis C Reports by Risk Behavior, Michigan, 2014………………………….… 35 Table 5.4b: Response of Completed Acute Hepatitis C Reports by Risk Behavior, Michigan, 2014………………….... 35 Figure 5.5 Prevalence of Genotypes of Chronic Hepatitis C Cases Reported, Michigan, 2014 …………………………… 36 Figure 5.6 Prevalence of Genotypes of Chronic Hepatitis C Cases, United States, 2014 ……………………………………. 36 2 | P a g e Table of Contents l Figure 5.7: Number of Chronic Hepatitis C Cases Reported to MDHHS by Year of Birth, 2004-2014…….………….… 37 Table 5.7 Number and Percentage of Chronic Hepatitis C cases reported to MDHHS aged 18-29, 2000-2014 ..… 37 Special Populations…………………………………………………………………………………………………………….…………………………………. 38 Hepatitis C in Young Adults …………….……………………………………………………………………………………….…………………………... 39 Figure 6.1 Number of Chronic Hepatitis C cases reported to MDHHS aged 18-29, 2000-2014 ………………….……… 39 Table 6.2 Heroin Substance Abuse Treatment Admissions and Heroin Overdose Deaths, 2000-2013………………. 39 Figure 6.2 Heroin Substance Abuse Treatment Admissions and Heroin Overdose Deaths, 2000-2013…………….. 40 Table 6.3 Epi Summary of 2014 Chronic HCV Cases Aged 18-29 ………………………………….………….…………..…………… 40 Viral Hepatitis and HIV Co-Infection……………………………………………………………………………………………………………………… 42 Table 8.1: Hepatitis B/ HIV Co-Infection Incidence, Michigan, 2004-2014…………………………………………………………. 42 Figure 8.2a: Hepatitis B and HIV Co-Infection Data, Michigan, 2014……………………………..…………………..…………….. 43 Figure 8.2b: Hepatitis C and HIV Co-Infection Data, Michigan, 2014……………………………..…………………..…………….. 44 Viral Hepatitis Outcomes …………………………………………………………………………………………….…………….…………………………. 45 Viral Hepatitis and Liver Cancer………………………………………………………………………………………………………………………….…. 46 Figure 9.1 Age-adjusted incidence rates of liver cancer by race and sex, Michigan, 2003-2011……………………....… 46 Figure 9.2 Age-adjusted death rates liver cancer by race and sex, Michigan, 2003-2012………………………………..….. 46 Liver Transplant …………………………………………………………………………………………………………………………………………….……... 48 Figure 10.1 Incidence of liver transplants and transplant waitlist patients, Michigan, 1988- 2013 …………………….. 48 Table 10.1 Incidence of liver transplants and transplant waitlist patients, Michigan, 1988- 2013……….………………. 49 Viral Hepatitis-Related Mortality…………………………………………………………………………………………………………………………... 50 Figure 11.1: Deaths Due to Acute and Chronic Hepatitis C, Michigan, 2003-2012…………………….…………………….…. 50 Figure 11.2: Mortality directly and indirectly attributed to viral hepatitis, Michigan, Michigan, 2003-2012 ….….. 51 Appendices…………………………………………………………………………………………………………….…………….………………………………. 53 Appendix A1: Hepatitis Date by County ……………………………………………………………………………………………….………….. 54 Appendix A2: Heroin Data by County………………………………………………………………………………………………….……………. 57 Appendix B1: Hepatitis Data by Local Health Jurisdiction ………………………………………………………………………………… 60 Appendix B2: Heroin Data by Local Health Jurisdiction ………………………………………………………………….….…………….. 62 Appendix C1: Hepatitis Data by Region ……………………………………………………………………….……….…………….….………… 64 Appendix C2: Heroin Data by Region………………………………………………………………………………………………………………… 65 Appendix D: Rate Maps …………………………………………………………………………………………………………………………………… 66 Acute Hepatitis B Rate Maps……………………………………………………………………………………………………………………. 66 Acute Hepatitis C Rate Maps……………………………………………………………………………………………………………………. 67 Chronic Hepatitis B Rate Maps…………………………………………………………………………………………………………………. 68 Chronic Hepatitis C Rate Maps…………………………………………………………………………………………………………………. 69 Young Adult HCV and Heroin Substance Abuse Treatment Admission and Overdose Death Rate Maps…... 70 3 | P a g e Table of Contents l Summary 4 | P a g e Viral Hepatitis Data Summary l Table 1.1. Summary of Demographic Information by Type of Hepatitis, Michigan, 2014 Acute % Acute Chronic % Chronic Acute % Acute Chronic % Chronic Variable Hepatitis B Hepatitis B Hepatitis B Hepatitis B Hepatitis C Hepatitis C Hepatitis C Hepatitis C n 50 100% 1141 100% 76 100% 8233 100% Sex Male 25 50.0% 645 56.5% 38 50.0% 5215 63.3% Female 25 50.0% 495 43.4% 38 50.0% 3000 36.4% Unknown 0 0.0% 1 0.1% 0 0.0% 18 0.2% Race or Ethnicity Caucasian 31 62.0% 285 25.0% 60 78.9% 4237 51.5% Black or African American 16 32.0% 208 18.2% 4 5.3% 1581 19.2% Hispanic 1 2.0% 18 1.6% 3 3.9% 167 2.0% Asian 1 2.0% 259 22.7% 0 0.0% 45 0.5% American Indian or Alaskan Native 1 2.0% 5 0.4% 3 3.9% 67 0.8% Other 0 0.0% 51 4.5% 1 1.3% 137 1.7% Unknown 1 2.0% 333 29.2% 8 10.5% 2166 26.3% Age Mean 46 46 35 48 Median 46 46 32 52 Range (28-71) (0-93) (0-68) (0-103) 0-19 0 0.0% 30 2.6% 3 3.9% 116 1.4% 20-29 4 8.0% 177 15.5% 30 39.5% 1365 16.6% 30-39 10 20.0% 227 19.9% 20 26.3% 1122 13.6% 40-49 18 36.0% 213 18.7% 9 11.8% 981 11.9% 50-59 11 22.0% 259 22.7% 8 10.5% 2484 30.2% 60+ 7 14.0% 234 20.5% 6 7.9% 2153 26.2% Unknown 0 0.0% 1 0.1% 0 0.0% 12 0.1% The summary table above was created to illustrate the differences in the demographic make-up between the various viral hepatitis classifications. For instance, males were more likely to have had a diagnosis of chronic hepatitis C infection in 2014, while