The Spatial Distribution of Hepatitis C Virus Infections and Associated Determinants--An Application of a Geographically Weighted Poisson Regression for Evidence-Based Screening Interventions in Hotspots.
BACKGROUND
Hepatitis C Virus (HCV) infections are a major cause for liver diseases. A large proportion of these infections remain hidden to care due to its mostly asymptomatic nature. Population-based screening and screening targeted on behavioural risk groups had not proven to be effective in revealing these hidden infections. Therefore, more practically applicable approaches to target screenings are necessary. Geographic Information Systems (GIS) and spatial epidemiological methods may provide a more feasible basis for screening interventions through the identification of hotspots as well as demographic and socio-economic determinants.


METHODS
Analysed data included all HCV tests (n = 23,800) performed in the southern area of the Netherlands between 2002-2008. HCV positivity was defined as a positive immunoblot or polymerase chain reaction test. Population data were matched to the geocoded HCV test data. The spatial scan statistic was applied to detect areas with elevated HCV risk. We applied global regression models to determine associations between population-based determinants and HCV risk. Geographically weighted Poisson regression models were then constructed to determine local differences of the association between HCV risk and population-based determinants.


RESULTS
HCV prevalence varied geographically and clustered in urban areas. The main population at risk were middle-aged males, non-western immigrants and divorced persons. Socio-economic determinants consisted of one-person households, persons with low income and mean property value. However, the association between HCV risk and demographic as well as socio-economic determinants displayed strong regional and intra-urban differences.


CONCLUSIONS
The detection of local hotspots in our study may serve as a basis for prioritization of areas for future targeted interventions. Demographic and socio-economic determinants associated with HCV risk show regional differences underlining that a one-size-fits-all approach even within small geographic areas may not be appropriate. Future screening interventions need to consider the spatially varying association between HCV risk and associated demographic and socio-economic determinants.
Department of Health, Ethics and Society, School of Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
Boris
B
Kauhl
Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service (GGD Zuid Limburg), Geleen, The Netherlands.
Jeanne
J
Heil
Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service (GGD Zuid Limburg), Geleen, The Netherlands; Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.
Christian J P A
CJ
Hoebe
Beuth University of Applied Sciences, Department III, Civil Engineering and Geoinformatics, Berlin, Germany.
Jürgen
J
Schweikart
Department of Health, Ethics and Society, School of Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
Thomas
T
Krafft
Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service (GGD Zuid Limburg), Geleen, The Netherlands; Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.
Nicole H T M
NH
Dukers-Muijrers
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D016000:Cluster Analysis; D005260:Female; D016174:Hepacivirus / Q000302:isolation & purification*; D006526:Hepatitis C / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D016018:Least-Squares Analysis; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D014505:Urban Population; D055815:Young Adult