Elsevier

Annals of Epidemiology

Volume 26, Issue 8, August 2016, Pages 570-578.e2
Annals of Epidemiology

Review article
A systematic review and meta-analysis of racial and ethnic disparities in hepatitis C antibody prevalence in United States correctional populations

https://doi.org/10.1016/j.annepidem.2016.06.013Get rights and content

Abstract

Purpose

Hepatitis C virus (HCV) is highly prevalent among correctional populations. We aimed to explore racial and ethnic disparities in hepatitis C antibody (anti-HCV) prevalence in U.S. correctional populations.

Methods

We systematically searched the literature for reports of anti-HCV prevalence among U.S. jail and prison populations, by race and ethnicity. We calculated summary prevalence estimates for non-Hispanic White, non-Hispanic Black, Hispanic, and “Other” race/ethnicity jail detainees and prisoners and determined the proportion of anti-HCV positive persons from racial/ethnic minority backgrounds.

Results

Few studies reported anti-HCV prevalence data by race and ethnicity, and they suffered from methodologic weaknesses. Anti-HCV prevalence was highest among non-Hispanic Whites (35% [95% CI: 28%, 43%; k = 9], compared to 26% [95% CI: 21%, 32%; k = 10] among racial and ethnic minorities). However, the majority (63%) of persons with anti-HCV were from racial and ethnic minority backgrounds.

Conclusions

Racial and ethnic minority persons appear to comprise the majority of HCV burden in U.S. correctional settings. Universal screening and treatment of HCV infection in correctional settings may impact on community-level health disparities.

Section snippets

Materials and methods

Reporting of this study is in accordance with the preferred reporting items for systematic reviews and meta-analyses checklist [16].

Results

The process of identifying studies for inclusion in the review is shown in Figure 1. We reviewed 23 studies of anti-HCV prevalence in U.S. correctional populations in full. One of these studies presented data for a mixed sample of adults and juveniles [27]. We had initially specified that only adult correctional populations would be included, but as juveniles comprised only 5% of the sample (31/596), we elected to include this study to maximize the number of studies reviewed. Two articles

Discussion

This systematic review and meta-analysis suggest that anti-HCV prevalence is higher among white entrants to correctional facilities, compared to racial and ethnic minority entrants. Considering the three most populous racial/ethnic groups, anti-HCV prevalence is highest among non-Hispanic whites, followed by Hispanics, then non-Hispanic blacks; this is a reversal of the extent to which these groups are incarcerated, with the highest incarceration rates among non-Hispanic blacks, and lowest

Conclusions

Racial and ethnic minority persons appear to comprise a substantial proportion of the HCV burden in correctional settings, but methodologically rigorous epidemiologic studies are needed to better understand HCV infection among people in jails and prisons, including racial and ethnic disparities.

Acknowledgments

This study was funded in part by fellowships to SL and LD from the Australian National Health and Medical Research Council (NHMRC #1035149, #1041742, respectively). The National Drug and Alcohol Research Centre at the University of NSW is supported by funding from the Australian Government under the Substance Misuse Prevention and Service Improvements Grants Fund.

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