According to Orman Hall, a research team member on the study and executive in residence at Ohio University's College of Health Sciences and Professions (CHSP), these findings support the notion that Appalachian Ohio has been the hardest hit area of the state's opioid epidemic. Dr. Rifat Haider, assistant professor in CHSP's Department of Social and Public Health, concurred.
"Hepatitis C is growing in incidence in southeast Ohio and it is directly linked to injectable drug use and injectable drug use is directly linked to opioid misuse," he said.
Research conducted by Haider showed national trends in injectable heroin use increased from 2015 to 2017. This increase created a rising trend in hepatitis incidences as well.
Hepatitis C is a blood-borne virus that infects the liver and is spread most commonly by sharing needles. Although curable, most who are infected suffer long-term health problems if left untreated and there is no vaccine for hepatitis C.
The Alliance's study focused on statistics from the Hepatitis Surveillance Program -- a service of the Ohio Department of Health -- from 2014 through 2018. Over those five years, 84,637 cases of hepatitis C were recorded in Ohio. After 12,012 cases were reported in 2014, and an increase to 15,581 cases in 2015, the number of hepatitis C incidents peaked in 2016 at 20,866 before dropping to 19,432 in 2017 and further decreased to 16,746 in 2018.
"Significant attention has been drawn to the severity of opioid overdose deaths within Ohio's Appalachian counties and overdose deaths are an important measure of the impact of the opioid epidemic in our state. However, it is important to note that overdose death rates can be influenced by a wide range of factors," Hall said. "Hepatitis C is often linked to intravenous drug use as one of the major sources of infection is the practice of sharing used (and potentially infected) needles. These findings illustrate the reported incidents of hepatitis C and suggests the prevalence of opioid misuse in various areas of the state."
According to the study, five southern Appalachia counties exhibited the highest five-year average hepatitis C rates per 100,000 population in the state, including:
- Pike -- 522
- Scioto -- 430
- Gallia -- 386
- Lawrence -- 370
- Meigs -- 314
Meanwhile, the counties of Putnam (30), Holmes (32), Delaware (52), Auglaize (52) and Geauga (57) had the lowest five-year average rates per 100,000 population.
Southern Appalachia had the highest average rates with northern Appalachia landing just below metropolitan areas for second highest reported incidents. In terms of age, those between 20-29 exhibited the highest hepatitis C rates, followed by 30-39 and 50-59 which had slightly higher rates than the 40-49 age bracket. Few incidents were recorded for persons under the age of 19.
Haider said he hopes the study will shine a light on the need for screenings for those at high-risk for the disease and that more physicians -- especially in areas of high opioid incidence -- should be provided the opportunity to present screening as an option for patients.
Dr. Sebastian Diaz, associate professor in the Heritage College of Osteopathic Medicine, added, "The data from this study promotes holistic perspectives of community health by highlighting interrelationships among hepatitis C and opioid use disorder rates. The Alliance's work in this regard is crucial toward providing community health stakeholders with these invaluable perspectives."
A full report of the statistics from the study -- including a county-by-county breakdown -- is available online. Previous studies conducted by The Alliance are also available.