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Neighborhood Inequalities in Hepatitis C Mortality: Spatial and Temporal Patterns and Associated Factors

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Abstract

Deaths attributable to hepatitis C (HCV) infection are increasing in the USA even as highly effective treatments become available. Neighborhood-level inequalities create barriers to care and treatment for many vulnerable populations. We seek to characterize citywide trends in HCV mortality rates over time and identify and describe neighborhoods in New York City (NYC) with disproportionately high rates and associated factors. We used a multiple cause of death (MCOD) definition for HCV mortality. Cases identified between January 1, 2006, and December 31, 2014, were geocoded to NYC census tracts (CT). We calculated age-adjusted HCV mortality rates and identified spatial clustering using a local Moran’s I test. Temporal trends were analyzed using joinpoint regression. A multistep global and local Poisson modeling approach was used to test for neighborhood associations with sociodemographic indicators. During the study period, 3697 HCV-related deaths occurred in NYC, with an average annual percent increase of 2.6% (p = 0.02). The HCV mortality rates ranged from 0 to 373.6 per 100,000 by CT, and cluster analysis identified significant clustering of HCV mortality (I = 0.23). Regression identified positive associations between HCV mortality and the proportion of non-Hispanic black or Hispanic residents, neighborhood poverty, education, and non-English-speaking households. Local regression estimates identified spatially varying patterns in these associations. The rates of HCV mortality in NYC are increasing and vary by neighborhood. HCV mortality is associated with many indicators of geographic inequality. Results identified neighborhoods in greatest need for place-based interventions to address social determinants that may perpetuate inequalities in HCV mortality.

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Authors and Affiliations

  1. Primary Care Development Corporation, 45 Broadway, New York, NY, 10006, USA

    Mary M. Ford

  2. Bureau of Communicable Diseases, New York City Department of Health and Mental Hygiene, Long Island City, NY, 11101, USA

    Payal S. Desai

  3. New York City Department of Health and Mental Hygiene, Bureau of Vital Statistics, New York, NY, 10013, USA

    Gil Maduro

  4. New York City Department of Homeless Services, New York, NY, 10014, USA

    Fabienne Laraque

Authors
  1. Mary M. Ford
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  2. Payal S. Desai
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  3. Gil Maduro
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  4. Fabienne Laraque
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Corresponding author

Correspondence to Mary M. Ford.

Additional information

Thumbnail Sketch: Hepatitis C (HCV) mortality rates are increasing in the USA, exceeding those of HIV in many communities. HCV disproportionately affects persons living in poverty, and community-based interventions may be particularly useful to target high-risk populations. This is the first study examining inequalities in HCV mortality by census tract in New York City (NYC). The study found increasing rates of HCV mortality in NYC and over two thirds of decedents to be less than 65 years of age. HCV mortality rates were associated with multiple indicators of socioeconomic inequality and varied by neighborhood.

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Ford, M.M., Desai, P.S., Maduro, G. et al. Neighborhood Inequalities in Hepatitis C Mortality: Spatial and Temporal Patterns and Associated Factors. J Urban Health 94, 746–755 (2017). https://doi.org/10.1007/s11524-017-0174-x

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  • DOI: https://doi.org/10.1007/s11524-017-0174-x

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