Editing Hepatitis C (section)

== Epidemiology ==

{{Update|section|date=July 2020}}
[[File:Countries Most Affected by Hepatitis C in 2019.png|alt=World map showing hepatitis C infection rate by country in 2019|thumb|Percentage of people infected with hepatitis C by country in 2019]]
The [[World Health Organization]] estimated in a 2021 report that 58 million people globally were living with chronic hepatitis C as of 2019.<ref name=":1" /> About 1.5 million people are infected per year, and about 290,000 people die yearly from hepatitis C–related diseases, mainly from liver cancer and cirrhosis.<ref name=whofactsheet/>

Hepatitis C infection rates increased substantially in the 20th century due to a combination of intravenous drug abuse and the reuse of poorly sterilized medical equipment.<ref name="World2007" /> However, advancements in treatment have led to notable declines in chronic infections and deaths from the virus. As a result, the number of chronic patients receiving treatment worldwide has grown from about 950,000 in 2015 to 9.4 million in 2019. During the same period, hepatitis C deaths declined from about 400,000 to 290,000.<ref name=whofactsheet /><ref name=":1" />

Previously, a 2013 study found high infection rates (>3.5% population infected) in [[Central Asia|Central]] and [[East Asia]], [[Middle East and North Africa|North Africa and the Middle East]], intermediate infection rates (1.5–3.5%) in South and [[Southeast Asia]], [[sub-Saharan Africa]], [[Andean civilizations|Andean]], Central and Southern Latin America, Caribbean, Oceania, Australasia and Central, Eastern and Western Europe; and low infection rates (<1.5%) in Asia-Pacific, Tropical Latin America and North America.<ref name="Mohd2013">{{cite journal | vauthors = Mohd Hanafiah K, Groeger J, Flaxman AD, Wiersma ST | title = Global epidemiology of hepatitis C virus infection: new estimates of age-specific antibody to HCV seroprevalence | journal = Hepatology | volume = 57 | issue = 4 | pages = 1333–42 | date = April 2013 | pmid = 23172780 | doi = 10.1002/hep.26141 | s2cid = 16265266 | doi-access = free }}</ref>

Among those chronically infected, the risk of [[cirrhosis]] after 20 years varies between studies but has been estimated at ~10–15% for men and ~1–5% for women. The reason for this difference is not known. Once cirrhosis is established, the rate of developing [[hepatocellular carcinoma]] is ~1–4% per year.<ref name=Yu2009>{{cite journal | vauthors = Yu ML, Chuang WL | title = Treatment of chronic hepatitis C in Asia: when East meets West | journal = Journal of Gastroenterology and Hepatology | volume = 24 | issue = 3 | pages = 336–45 | date = March 2009 | pmid = 19335784 | doi = 10.1111/j.1440-1746.2009.05789.x | s2cid = 27333980 | doi-access = free }}</ref> Rates of new infections have decreased in the Western world since the 1990s due to improved screening of blood before transfusion.<ref name=Tah2009 />

In Egypt, following [[Egypt Vision 2030|Egypt's 2030 Vision]], the country managed to bring down the infection rates of hepatitis C from 22% in 2011 to just 2% in 2021.<ref name="egypttoday.com">{{Cite web |date=2021-02-06 |title=Hepatitis C prevalence in Egypt drops from 7% to 2% thanks to Sisi's initiative |url=https://www.egypttoday.com/Article/1/98273/Hepatitis-C-prevalence-in-Egypt-drops-from-7-to-2 |access-date=2021-03-06 |website=EgyptToday}}</ref> It was believed that the high prevalence in Egypt was linked to a discontinued mass-treatment campaign for [[schistosomiasis]], using improperly sterilized glass syringes.<ref name="World2007" />

In the United States, about 2% of people have chronic {{nowrap|hepatitis C}}.<ref name=AFP2010 /> In 2014, an estimated 30,500 new acute hepatitis C cases occurred (0.7 per 100,000 population), an increase from 2010 to 2012.<ref>{{cite web |title =Surveillance for Viral Hepatitis – United States, 2014  |publisher = CDC |url = https://www.cdc.gov/hepatitis/statistics/2014surveillance/commentary.htm#bkgrndC |date=May 17, 2016 |access-date = 2016-08-04 |url-status = live |archive-url = https://web.archive.org/web/20160808042215/http://www.cdc.gov/hepatitis/statistics/2014surveillance/commentary.htm#bkgrndC |archive-date = 2016-08-08 }}</ref> The number of deaths from hepatitis C rose to 15,800 in 2008<ref>{{cite web |title=Table 4.5. Number and rate* of deaths with hepatitis C listed as a cause of death†, by demographic characteristic and year — the United States, 2004–2008 |date=June 7, 2012 |url=https://www.cdc.gov/hepatitis/Statistics/2010Surveillance/Table4.5.htm|work=Viral Hepatitis Statistics & Surveillance |publisher=Centers for Disease Control and Prevention |location= Atlanta, GA|access-date=28 July 2013|url-status=dead |archive-url=https://web.archive.org/web/20140309141408/http://www.cdc.gov/hepatitis/Statistics/2010Surveillance/Table4.5.htm|archive-date=9 March 2014}}</ref> having overtaken HIV/AIDS as a cause of death in the US in 2007.<ref>{{cite news|title=Hepatitis C Deaths Creep Past AIDS, Study Finds |first1=Nicholas |last1=Bakalar |url=https://www.nytimes.com/2012/02/28/health/research/hepatitis-c-deaths-creep-past-aids-study-finds.html |url-access=subscription |access-date=28 July 2013|newspaper=New York Times|date=27 February 2012|url-status=live|archive-url=https://web.archive.org/web/20170630112442/http://www.nytimes.com/2012/02/28/health/research/hepatitis-c-deaths-creep-past-aids-study-finds.html?_r=0|archive-date=30 June 2017}}</ref> In 2014, it was the single greatest cause of infectious death in the United States.<ref name="CDC2016a">{{cite web|title=Hepatitis C Kills More Americans than Any Other Infectious Disease|url=https://www.cdc.gov/media/releases/2016/p0504-hepc-mortality.html|publisher=Centers for Disease Control and Prevention|access-date=3 August 2016|date=May 4, 2016|url-status=live|archive-url=https://web.archive.org/web/20160809080556/http://www.cdc.gov/media/releases/2016/p0504-hepc-mortality.html|archive-date=9 August 2016}}</ref> This mortality rate is expected to increase, as those infected by transfusion before HCV testing become apparent.<ref name=Cola2004>{{cite book | veditors = Colacino JM, Heinz BA | vauthors = Blatt LM, Tong M |title=Hepatitis prevention and treatment |year=2004 |publisher=Birkhäuser |location=Basel |isbn=978-3-7643-5956-0 |page=32 |url=https://books.google.com/books?id=KwSWN_QtVLUC&pg=PA32 |url-status=live |archive-url=https://web.archive.org/web/20160624071639/https://books.google.com/books?id=KwSWN_QtVLUC&pg=PA32 |archive-date=2016-06-24 }}</ref> In Europe, the percentage of people with chronic infections has been estimated to be between 0.13 and 3.26%.<ref>{{cite journal | vauthors = Blachier M, Leleu H, Peck-Radosavljevic M, Valla DC, Roudot-Thoraval F | title = The burden of liver disease in Europe: a review of available epidemiological data | journal = Journal of Hepatology | volume = 58 | issue = 3 | pages = 593–608 | date = March 2013 | pmid = 23419824 | doi = 10.1016/j.jhep.2012.12.005 | doi-access = free }}</ref>

In the United Kingdom, about 118,000 people were chronically infected in 2019.<ref>{{cite web | title=Hepatitis C |publisher=NHS UK| date=27 October 2021 | url=https://www.nhs.uk/conditions/hepatitis-c/}}</ref> About half of people using a needle exchange in London in 2017–18 tested positive for hepatitis C of which half were unaware that they had it.<ref>{{cite journal| title=More than half of patients using needle exchange pilot tested positive for Hepatitis C| vauthors = Burns C | website=The Pharmaceutical Journal | date=17 May 2018| url=https://pharmaceutical-journal.com/article/news/more-than-half-of-patients-using-needle-exchange-pilot-tested-positive-for-hepatitis-c}}</ref> As part of a bid to eradicate hepatitis C by 2025, [[NHS England]] conducted a large procurement exercise in 2019. [[Merck Sharp & Dohme]], [[Gilead Sciences]], and [[Abbvie]] were awarded contracts, which, together, are worth up to £1 billion over five years.<ref>{{cite news |title=Legal action firm among winners for largest medicines procurement |url=https://www.hsj.co.uk/quality-and-performance/legal-action-firm-among-winners-for-largest-medicines-procurement/7024966.article |access-date=9 June 2019 |publisher=Health Service Journal |date=30 April 2019}}</ref>

The total number of people with this infection is higher in some countries in Africa and Asia.<ref>{{cite book | vauthors = Holmberg S| veditors = Brunette GW, Kozarsky PE, Magill AJ, Shlim DR, Whatley AD |title=CDC Health Information for International Travel 2012 |publisher=Oxford University Press |location=New York |isbn=978-0-19-976901-8 |page=[https://archive.org/details/cdchealthinforma0000unse/page/231 231] |url=https://archive.org/details/cdchealthinforma0000unse/page/231 |date=2011-05-12 |url-access=registration }}</ref> Countries with particularly high rates of infection include Pakistan (4.8%) and China (3.2%).<ref name=WHO2011>{{cite web |title=Hepatitis C |publisher=World Health Organization (WHO) |url=https://www.who.int/mediacentre/factsheets/fs164/en/index.html |date=June 2011 |access-date=2011-07-13 |url-status=live |archive-url=https://web.archive.org/web/20110712194903/http://www.who.int/mediacentre/factsheets/fs164/en/index.html |archive-date=2011-07-12 }}</ref>

Since 2014, extremely effective treatments have been available to eradicate the disease within 8–12 weeks in most people.<ref name=":0">{{cite journal | vauthors = Lombardi A, Mondelli MU | title = Hepatitis C: Is eradication possible? | journal = Liver International | volume = 39 | issue = 3 | pages = 416–426 | date = March 2019 | pmid = 30472772 | doi = 10.1111/liv.14011 | doi-access = free | hdl = 2434/870308 | hdl-access = free }}</ref> In 2015, about 950,000 people were treated while 1.7 million new infections occurred, meaning that overall the number of people with HCV increased.<ref name=":0" /> These numbers differ by country and improved in 2016, with some countries achieving higher cure rates than new infection rates (mostly high-income countries).<ref name=":0" /> By 2018, twelve countries are on track to achieve HCV elimination.<ref name=":0" /> While antiviral agents will curb new infections, it is less clear whether they impact overall deaths and morbidity.<ref name=":0" /> Furthermore, for them to be effective, people need to be aware of their infection – it is estimated that worldwide only 20% of infected people are aware of their infection (in the US, fewer than half were aware).<ref name=":0" />