title: A population-based study of chronic hepatitis C in immigrants and non-immigrants in Quebec, Canada.
abstract: Immigrants originating from intermediate and high HCV prevalence countries may be at increased risk of exposure to hepatitis C infection (HCV) in their countries of origin, however they are not routinely screened after arrival in most low HCV prevalence host countries. We aimed to describe the epidemiology of HCV in immigrants compared to the Canadian born population.
  
  
  
  Using the reportable infectious disease database linked to the landed immigration database and several provincial administrative databases, we assembled a cohort of all reported cases of HCV in Quebec, Canada (1998-2008). Underlying co-morbidities were identified in the health services databases. Stratum specific rates of reported cases/100,000, rate ratios (RRs) and trends over the study period were estimated.
  
  
  
  A total of 20,862 patients with HCV were identified, among whom 1922 (9.2%) were immigrants. Immigrants were older and diagnosed a mean of 9.8 ± 7 years after arrival. The Canadian born population was more likely to have behavior co-morbidities (problematic alcohol or drug use) and HIV co-infection. Immigrants from Sub-Saharan Africa, Asia and Eastern Europe had the highest HCV reported rates with RRs compared to non-immigrants ranging from 1.5 to 1.7. The age and sex adjusted rates decreased by 4.9% per year in non-immigrants but remained unchanged in immigrants. The proportion of HCV occurring in immigrants doubled over the study period from 5 to 11%.
  
  
  
  Immigrants from intermediate and high HCV prevalence countries are at increased risk for HCV and had a mean delay in diagnosis of almost 10 years after arrival suggesting that they may benefit from targeted HCV screening and earlier linkage to care.
authors.affiliation: Division of Infectious Diseases, Jewish General Hospital, McGill University, 3755 Côte St. Catherine Road, Room E-0057, Montreal, PQ H3T 1E2, Canada. ca.greenaway@mcgill.ca.|Centre for Clinical Epidemiology, Lady Davis Research Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Canada. ca.greenaway@mcgill.ca.
authors.forename: Christina
authors.initials: C
authors.lastname: Greenaway
authors.affiliation: Centre for Clinical Epidemiology, Lady Davis Research Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Canada.|Department of Oncology, McGill University, Montreal, Canada.
authors.forename: Laurent
authors.initials: L
authors.lastname: Azoulay
authors.affiliation: Department of Oncology, McGill University, Montreal, Canada.|Montreal Public Health Department, Montreal, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Allard
authors.affiliation: Sexually Transmitted Infections Division, Montreal Public Health Department, Montreal, Canada.
authors.forename: Joseph
authors.initials: J
authors.lastname: Cox
authors.affiliation: Centre for Clinical Epidemiology, Lady Davis Research Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Canada.
authors.forename: Viet Anh
authors.initials: VA
authors.lastname: Tran
authors.affiliation: Centre for Clinical Epidemiology, Lady Davis Research Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Canada.
authors.forename: Claire Nour
authors.initials: CN
authors.lastname: Abou Chakra
authors.affiliation: Centre for Clinical Epidemiology, Lady Davis Research Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Canada.|Department of Mathematics and Statistics, McGill University, Montreal, Canada.
authors.forename: Russ
authors.initials: R
authors.lastname: Steele
authors.affiliation: Division of Infectious Diseases, McGill University Health Center, McGill University, Montreal, Canada.
authors.forename: Marina
authors.initials: M
authors.lastname: Klein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D060085:Coinfection / Q000453:epidemiology*; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data; D019353:Endemic Diseases / Q000517:prevention & control* / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D019698:Hepatitis C, Chronic / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011634:Public Health; D011792:Quebec / Q000453:epidemiology; D012107:Research Design; D012189:Retrospective Studies; D018571:Sentinel Surveillance; D016036:Seroepidemiologic Studies; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Hepatitis C; Immigrant; Incidence; Rates; Viral hepatitis