Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website https://gr.elmerpub.com

Original Article

Volume 18, Number 4, August 2025, pages 182-191

Trends in Hepatitis C and Hepatitis B Deaths Identify Successes and Disparities, Alameda County, CA, 2005 - 2022

Figure 1. Trends in hepatitis B and hepatitis C virus crude mortality rates^a per 100,000 population, Alameda County, 2005 - 2022. ^aIncludes decedents with HBV or HCV listed in multiple cause of death on death certificate; excludes decedents with both HBV and HCV listed. HBV: hepatitis B virus; HCV: hepatitis C virus.

Figure 2. Trends^a in age-adjusted hepatitis C virus mortality rates^b per 100,000 population by race/ethnicity^c, Alameda County, 2005 to 2022. ^aTrends in adjusted rates estimated using Joinpoint regression. ^bIncludes decedents with HCV listed in multiple cause of death on death certificate form; excludes decedents with both HBV and HCV listed. ^cToo few HCV decedents were categorized as American Indian and Alaska Native or Multirace to graph over time. AAPC: average annual percentage change; HCV: hepatitis C virus.

Figure 3. Trends^a in age-adjusted hepatitis C virus mortality rates^b per 100,000 population, by Census Tract HPI quartile, Alameda County, 2005 - 2022. ^aTrends in adjusted rates estimated using Joinpoint regression. ^bIncludes decedents with HCV listed in multiple cause of death on death certificate form; excludes decedents with both HBV and HCV listed. AAPC: average annual percentage change; HCV: hepatitis C virus; HPI: Healthy Places Index.

**Table 1.** Characteristics of Persons Who Died With HBV, HCV, or Co-Infection, Alameda County, 2005 - 2022
Characteristics	Total deaths, n (%)	HBV, n (%)^a	HCV, n (%)^a	P value^b
^aICD-10 coding definitions: HBV, B16, B17.0, B18.0, B18.1; HCV, B17.1, B18.2; HIV, B20.x-B24.x; diabetes, E10.x-E14.x; cardiovascular, IXX.x; drug dependence, X40.x-X44.x, Y10.x-Y16.x, X60.x-X64.x, F11.x, F13.x, F15.x; alcohol-associated liver disease, K70.x; hepatocellular carcinoma, C22.x, D37.6; cirrhosis, K71.7, K70.3, K74.1-K74.6; liver failure, K70.4, K72. ^bP value for tests of significance between HBV and HCV statuses. P value calculated using Kruskal-Wallis test for age and Chi-square test for all other variables. Note: Cells with counts < 10 and that are not unknown are suppressed as well as their complementary cells, indicated with a “-” to avoid inadvertent disclosure of identity. HBV: hepatitis B virus; HCV: hepatitis C virus; HIV: human immunodeficiency virus; HPI: Healthy Places Index; IQR: interquartile range.
Total	2,122	313	1,809	-
Sex
Female	664 (31.3)	81 (25.9)	583 (32.2)	0.03
Male	1,458 (68.7)	232 (74.1)	1,226 (67.8)
Race and ethnicity
African American/Black	640 (30.2)	29 (9.3)	611 (33.8)	< 0.001
American Indian/Alaskan Native	10 (0.5)	0 (0.0)	10 (0.6)
Asian	357 (16.8)	229 (73.2)	128 (7.1)
Hispanic/Latinx	330 (15.6)	10 (3.2)	320 (17.7)
Pacific Islander	16 (0.8)	-	-
Multirace	-	-	43 (2.4)
White	714 (33.6)	32 (10.2)	682 (37.7)
Unknown	-	-	-
Age (median (IQR))	62 (56, 69)	65 (57, 73)	62 (56, 69)	0.001
Nativity
Born in the United States	1,541 (72.6)	61 (19.5)	1,480 (81.8)	< 0.001
Born outside the United States	504 (23.8)	247 (78.9)	257 (14.2)
Unknown	77 (3.6)	5 (1.6)	72 (4.0)
HPI quartile
1	330 (15.6)	23 (7.3)	307 (17.0)	< 0.001
2	582 (27.4)	91 (29.1)	491 (27.1)
3	611 (28.8)	98 (31.3)	513 (28.4)
4	543 (25.6)	98 (31.3)	445 (24.6)
Unknown	56 (2.6)	3 (1.0)	53 (2.9)
Selected other causes of death^a
HIV	-	-	60 (3.3)	0.15
Diabetes	299 (14.1)	43 (13.7)	256 (14.2)	0.92
Cardiovascular	982 (46.3)	127 (40.6)	855 (47.3)	0.03
Drug dependence	-	-	36 (2.0)	0.06
Alcohol-associated liver disease	213 (10.0)	8 (2.6)	205 (11.3)	< 0.001
Hepatocellular carcinoma	491 (23.1)	115 (36.7)	376 (20.8)	< 0.001
Cirrhosis	902 (42.5)	109 (34.8)	793 (43.8)	0.004
Liver failure	356 (16.8)	43 (13.7)	313 (17.3)	0.14

Table 1. Characteristics of Persons Who Died With HBV, HCV, or Co-Infection, Alameda County, 2005 - 2022

Characteristics

Total deaths, n (%)

HBV, n (%)^a

HCV, n (%)^a

P value^b

^aICD-10 coding definitions: HBV, B16, B17.0, B18.0, B18.1; HCV, B17.1, B18.2; HIV, B20.x-B24.x; diabetes, E10.x-E14.x; cardiovascular, IXX.x; drug dependence, X40.x-X44.x, Y10.x-Y16.x, X60.x-X64.x, F11.x, F13.x, F15.x; alcohol-associated liver disease, K70.x; hepatocellular carcinoma, C22.x, D37.6; cirrhosis, K71.7, K70.3, K74.1-K74.6; liver failure, K70.4, K72. ^bP value for tests of significance between HBV and HCV statuses. P value calculated using Kruskal-Wallis test for age and Chi-square test for all other variables. Note: Cells with counts < 10 and that are not unknown are suppressed as well as their complementary cells, indicated with a “-” to avoid inadvertent disclosure of identity. HBV: hepatitis B virus; HCV: hepatitis C virus; HIV: human immunodeficiency virus; HPI: Healthy Places Index; IQR: interquartile range.

Total

2,122

313

1,809

Sex

Female

664 (31.3)

81 (25.9)

583 (32.2)

0.03

Male

1,458 (68.7)

232 (74.1)

1,226 (67.8)

Race and ethnicity

African American/Black

640 (30.2)

29 (9.3)

611 (33.8)

< 0.001

American Indian/Alaskan Native

10 (0.5)

0 (0.0)

10 (0.6)

Asian

357 (16.8)

229 (73.2)

128 (7.1)

Hispanic/Latinx

330 (15.6)

10 (3.2)

320 (17.7)

Pacific Islander

16 (0.8)

Multirace

43 (2.4)

White

714 (33.6)

32 (10.2)

682 (37.7)

Unknown

Age (median (IQR))

62 (56, 69)

65 (57, 73)

62 (56, 69)

0.001

Nativity

Born in the United States

1,541 (72.6)

61 (19.5)

1,480 (81.8)

< 0.001

Born outside the United States

504 (23.8)

247 (78.9)

257 (14.2)

Unknown

77 (3.6)

5 (1.6)

72 (4.0)

HPI quartile

330 (15.6)

23 (7.3)

307 (17.0)

< 0.001

582 (27.4)

91 (29.1)

491 (27.1)

611 (28.8)

98 (31.3)

513 (28.4)

543 (25.6)

98 (31.3)

445 (24.6)

Unknown

56 (2.6)

3 (1.0)

53 (2.9)

Selected other causes of death^a

HIV

60 (3.3)

0.15

Diabetes

299 (14.1)

43 (13.7)

256 (14.2)

0.92

Cardiovascular

982 (46.3)

127 (40.6)

855 (47.3)

0.03

Drug dependence

36 (2.0)

0.06

Alcohol-associated liver disease

213 (10.0)

8 (2.6)

205 (11.3)

< 0.001

Hepatocellular carcinoma

491 (23.1)

115 (36.7)

376 (20.8)

< 0.001

Cirrhosis

902 (42.5)

109 (34.8)

793 (43.8)

0.004

Liver failure

356 (16.8)

43 (13.7)

313 (17.3)

0.14

**Table 2.** AAPC and APC in HCV Mortality Rates^a Per 100,000 Population, by Race and Ethnicity and Census Tract HPI Quartile, Alameda County, 2005 - 2022
Group	Time period	AAPC (95% CI)^b	APC (95% CI)^c
^aIncludes decedents with HBV or HCV listed in multiple cause of death on death certificate; excludes decedents with both HBV and HCV listed. ^b10-year (2013 - 2022) AAPCs were calculated for all groups. APC periods are dependent on best model fit for that particular group. AAPCs and APCs were calculated using Joinpoint regression. ^cP < 0.05 for all AAPCs. Note: “-“ indicates N/A. AAPC: average annual percent change; APC: annual percent change; 95% CI: 95% confidence interval; HCV: hepatitis C virus; HPI: Healthy Places Index.
Race/ethnicity
Asian	2013 - 2022	-15.0 (-25.4, -9.4)	-
	2005 - 2010	-	19.8 (-4.9, 149.3)
	2010 - 2022	-	-15.0 (-48.6, -9.5)
African American/Black	2013 - 2022	-8.4 (-12.3, -6.4)	-
	2005 - 2008	-	18.4 (3.4, 52.2)
	2008 - 2016	-	0.7 (-22.9, 5)
	2016 - 2022	-	-12.6 (-29.5, 2)
Hispanic/Latinx	2013 - 2022	-5.7 (-11, -2.8)	-
	2005 - 2008	-	20.0 (-3.3, 70.9)
	2008 - 2022	-	-5.7 (-21.3, -2.7)
White	2013 - 2022	-11.3 (-16.1, -6.8)	-
	2005 - 2012	-	9.7 (1.1, 31.6)
	2012 - 2022	-	-11.3 (-19.5, -6.8)
HPI
Quartile 1	2013 - 2022	-4.5 (-10.6, -1.2)	-
	2005 - 2008	-	27.5 (-0.9, 107.2)
	2008 - 2022	-	-4.5 (-31.1, -1.2)
Quartile 2	2013 - 2022	-9.5 (-13.5, -5.6)	-
	2005 - 2012	-	5.9 (-1.2, 29.2)
	2012 - 2022	-	-9.5 (-19.2, -5.7)
Quartile 3	2013 - 2022	-11.2 (-13.4, -9.1)	-
	2005 - 2012	-	-0.9 (-4.6, 6.6)
	2012 - 2022	-	-11.2 (-14.6, -9.1)
Quartile 4	2013 - 2022	-12.8 (-16.4, -9.9)	-
	2005 - 2009	-	28.0 (8, 73.1)
	2009 - 2022	-	-12.8 (-16.6, -9.9)

Table 2. AAPC and APC in HCV Mortality Rates^a Per 100,000 Population, by Race and Ethnicity and Census Tract HPI Quartile, Alameda County, 2005 - 2022

Group

Time period

AAPC (95% CI)^b

APC (95% CI)^c

^aIncludes decedents with HBV or HCV listed in multiple cause of death on death certificate; excludes decedents with both HBV and HCV listed. ^b10-year (2013 - 2022) AAPCs were calculated for all groups. APC periods are dependent on best model fit for that particular group. AAPCs and APCs were calculated using Joinpoint regression. ^cP < 0.05 for all AAPCs. Note: “-“ indicates N/A. AAPC: average annual percent change; APC: annual percent change; 95% CI: 95% confidence interval; HCV: hepatitis C virus; HPI: Healthy Places Index.

Race/ethnicity

Asian

2013 - 2022

-15.0 (-25.4, -9.4)

2005 - 2010

19.8 (-4.9, 149.3)

2010 - 2022

-15.0 (-48.6, -9.5)

African American/Black

2013 - 2022

-8.4 (-12.3, -6.4)

2005 - 2008

18.4 (3.4, 52.2)

2008 - 2016

0.7 (-22.9, 5)

2016 - 2022

-12.6 (-29.5, 2)

Hispanic/Latinx

2013 - 2022

-5.7 (-11, -2.8)

2005 - 2008

20.0 (-3.3, 70.9)

2008 - 2022

-5.7 (-21.3, -2.7)

White

2013 - 2022

-11.3 (-16.1, -6.8)

2005 - 2012

9.7 (1.1, 31.6)

2012 - 2022

-11.3 (-19.5, -6.8)

HPI

Quartile 1

2013 - 2022

-4.5 (-10.6, -1.2)

2005 - 2008

27.5 (-0.9, 107.2)

2008 - 2022

-4.5 (-31.1, -1.2)

Quartile 2

2013 - 2022

-9.5 (-13.5, -5.6)

2005 - 2012

5.9 (-1.2, 29.2)

2012 - 2022

-9.5 (-19.2, -5.7)

Quartile 3

2013 - 2022

-11.2 (-13.4, -9.1)

2005 - 2012

-0.9 (-4.6, 6.6)

2012 - 2022

-11.2 (-14.6, -9.1)

Quartile 4

2013 - 2022

-12.8 (-16.4, -9.9)

2005 - 2009

28.0 (8, 73.1)

2009 - 2022

-12.8 (-16.6, -9.9)