title: Burden of Hepatitis C Virus Infection Among Older Adults in Long-Term Care Settings: a Systematic Review of the Literature and Meta-Analysis.
abstract: Hepatitis C virus (HCV) infection is a significant cause of morbidity and mortality worldwide. The magnitude of the HCV burden has previously been the subject of debate, as representative data tend to exclude high-risk populations, including institutionalized persons. The purpose of this systematic review and meta-analysis was to estimate the prevalence of HCV infection among older adults in long-term care (LTC) and assess factors associated with the prevalence of HCV in this setting. The Preferred Reporting Items for Systematic Review and Meta-Analyses checklist was used as the methodological guide. Two reviewers independently assessed the study quality using a validated modified quality assessment tool. Six articles met inclusion criteria; the majority were cross-sectional studies (83.3 %) designed to estimate HCV infection prevalence rates and identify associated risk factors. HCV prevalence ranged from 1.4 to 11.8 %. A pooled HCV infection prevalence of 3.3 % (95 % confidence interval: 1.5-7.2 %) was estimated based on 1920 LTC residents with substantial heterogeneity noted (Q = 51.1, p < 0.001; I (2) = 90.2). Three of six studies reported statistically significant factors associated with an increased risk for HCV infection, including older age, female gender, history of blood transfusions, short duration of LTC residence, and hepatitis B virus positivity. This study reports a higher prevalence of HCV infection among older adults in LTC settings compared to community-dwelling older adults; however, accurate estimation of prevalence is limited by heterogeneity between and within studies, variation in sampling and recruitment methodologies, and absence of the HCV-RNA test to confirm active infection.
authors.affiliation: New York State Department of Health, Metropolitan Area Regional Office, Bureau of Communicable Disease Control, 145 Huguenot Street, Suite 603, New Rochelle, NY, 10801, USA. kimberly.alvarez@health.ny.gov.
authors.forename: Kimberly J
authors.initials: KJ
authors.lastname: Alvarez
authors.affiliation: Columbia School of Nursing, Columbia University, 617 West 168th Street, New York, NY, 10032, USA.
authors.forename: Arlene
authors.initials: A
authors.lastname: Smaldone
authors.affiliation: Columbia School of Nursing, Columbia University, 617 West 168th Street, New York, NY, 10032, USA.|Center for Interdisciplinary Research to Prevent Infection, Columbia School of Nursing, Columbia University, 617 West 168th Street, New York, New York, 10032, USA.
authors.forename: Elaine L
authors.initials: EL
authors.lastname: Larson
keywords: Aging; Hepatitis C virus; Long-term care; Older adults