Date of Award
Master of Public Health (MPH)
Richard Rothenberg, MD, MPH, FACP
Sheryl Strasser, PhD
Ike Okosun, M.S., MPH, PhD, FRIPH, FRSH
Background: Approximately 170 million persons are infected with the hepatitis C viral infection (HCV), globally. Of this number, 3.2 – 4 million persons in the U. S. are infected with HCV. Although previous research has indicated a decrease in the rates of Hepatitis C in the U.S. approximately 12,000 deaths occur annually from those who suffer from chronic liver disease, as a result of being chronic carriers of HCV. Being a recipient of blood transfusions prior to 1992, intravenous drug users (IDUs), or persons with multiple sex partners are associated with increased risk for HCV infection. IDUs constitute the largest cohort for those infected with HCV. Due to the few clinical manifestations HIV and HCV share and HIV patients living longer due to Highly Active Antiretroviral Therapy (HAART), Many individuals infected with HIV are discovering co-morbidities with HCV. Methods: Secondary Data from the State Electronic Notifiable Disease Surveillance System (SENDSS) were used to analyze all confirmed cases of hepatitis C in the state of Georgia for the year 2009. All subjects in this analysis were confirmed as Hepatitis C infected. Descriptive frequencies for all categorical data were tested and analyzed, which included: gender, race, geographic region, disease status, age distribution, risk factor data such as injection drug use, blood transfusion prior to 1992, long term hemodialysis, accidental needle stick, tattoo, sexual contacts, and incarceration. Binary logistic regression for univariate and multivariate analysis was used to test the associations between geographic region of all HCV cases and their demographic characteristics. Results: Descriptive analysis of the prevalence of HCV cases in Georgia in 2009 reveal higher rates of HCV in rural regions (GOA) of the state among White males of non-Hispanic origin. In this same region, these cases were more likely to report risk factors involving injection drug use, blood transfusions prior to 1992, incarceration, or tattoos. Prevalence of most cases of HCV in Georgia for the year 2009 are seen in those age 20 – 30 and those 40 – 60. A higher number of those reporting intravenous drug use in metropolitan Atlanta (MSA) are Black of non-Hispanic origin. Bivariate logistic regression reveals that White Non-Hispanics living in rural areas of Georgia (GOA) have a 3.48 higher odds of being infected with Hepatitis C than Black Non-Hispanics (OR = 3.48, p < 0.001, CI 2.54 – 4.77). Conclusion: Resources for prevention of Hepatitis C should be directed to marginalized communities within Georgia regions outside of the Atlanta Metropolitan Statistical Area. The primary focus of prevention should also be tailored to new initiates of intravenous drug use and those 20 – 30 and 40 – 60 years of age. Further knowledge and understanding of behaviors that put individuals at risk for acquiring Hepatitis C, such as intravenous drug use, in rural Georgia may warrant interventions tailored to benefit these communities from acquiring or spreading Hepatitis C.
Terrell, Terran A., "A Geographical Examination of Social, Behavioral, and Demographic Determinants Association with Hepatitis C Viral Infection in the State of Georgia." Thesis, Georgia State University, 2010.