title: Toward a more accurate estimate of the prevalence of hepatitis C in the United States.
abstract: Data from the 2003-2010 National Health and Nutrition Examination Survey (NHANES) indicate that about 3.6 million people in the United States have antibodies to the hepatitis C virus, of whom 2.7 million are currently infected. NHANES, however, excludes several high-risk populations from its sampling frame, including people who are incarcerated, homeless, or hospitalized; nursing home residents; active-duty military personnel; and people living on Indian reservations. We undertook a systematic review of peer-reviewed literature and sought out unpublished presentations and data to estimate the prevalence of hepatitis C in these excluded populations and in turn improve the estimate of the number of people with hepatitis C in the United States. The available data do not support a precise result, but we estimated that 1.0 million (range 0.4 million-1.8 million) persons excluded from the NHANES sampling frame have hepatitis C virus antibody, including 500,000 incarcerated people, 220,000 homeless people, 120,000 people living on Indian reservations, and 75,000 people in hospitals. Most are men. An estimated 0.8 million (range 0.3 million-1.5 million) are currently infected. Several additional sources of underestimation, including nonresponse bias and the underrepresentation of other groups at increased risk of hepatitis C that are not excluded from the NHANES sampling frame, were not addressed in this study.
  
  
  CONCLUSIONS
  The number of US residents who have been infected with hepatitis C is unknown but is probably at least 4.6 million (range 3.4 million-6.0 million), and of these, at least 3.5 million (range 2.5 million-4.7 million) are currently infected; additional sources of potential underestimation suggest that the true prevalence could well be higher.
authors.affiliation: Department of Medicine, Weill Cornell Medical College, New York, NY.|Institute for Infectious Disease Research, National Development and Research Institutes, New York, NY.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Edlin
authors.affiliation: Department of Medicine, Weill Cornell Medical College, New York, NY.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Eckhardt
authors.affiliation: Department of Psychiatry, Beth Israel Medical Center, New York, NY.
authors.forename: Marla A
authors.initials: MA
authors.lastname: Shu
authors.affiliation: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Holmberg
authors.affiliation: Treatment Action Group, New York, NY.
authors.forename: Tracy
authors.initials: T
authors.lastname: Swan
mesh_terms: D005260:Female; D006526:Hepatitis C / Q000453:epidemiology*; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D008297:Male; D015995:Prevalence; D014481:United States / Q000453:epidemiology
chemical_list: D018937:Hepatitis C Antibodies