Chronic hepatitis C virus infection in the United States, National Health and Nutrition Examination Survey 2003 to 2010

Ann Intern Med. 2014 Mar 4;160(5):293-300. doi: 10.7326/M13-1133.


Background: Knowledge of the number of persons with chronic hepatitis C virus (HCV) infection in the United States is critical for public health and policy planning.

Objective: To estimate the prevalence of chronic HCV infection between 2003 and 2010 and to identify factors associated with this condition.

Design: Nationally representative household survey.

Setting: U.S. noninstitutionalized civilian population.

Participants: 30,074 NHANES (National Health and Nutrition Examination Survey) participants between 2003 and 2010.

Measurements: Interviews to ascertain demographic characteristics and possible risks and exposures for HCV infection. Serum samples from participants aged 6 years or older were tested for antibody to HCV; if results were positive or indeterminate, the samples were tested for HCV RNA, which indicates current chronic infection.

Results: Based on 273 participants who tested positive for HCV RNA, the estimated prevalence of HCV infection was 1.0% (95% CI, 0.8% to 1.2%), corresponding to 2.7 million chronically infected persons (CI, 2.2 to 3.2 million persons) in the U.S. noninstitutionalized civilian population. Infected persons were more likely to be aged 40 to 59 years, male, and non-Hispanic black and to have less education and lower family income. Factors significantly associated with chronic HCV infection were illicit drug use (including injection drugs) and receipt of a blood transfusion before 1992; 49% of persons with HCV infection did not report either risk factor.

Limitation: Incarcerated and homeless persons were not surveyed.

Conclusion: This analysis estimated that approximately 2.7 million U.S. residents in the population sampled by NHANES have chronic HCV infection, about 500,000 fewer than estimated in a similar analysis between 1999 and 2002. These data underscore the urgency of identifying the millions of persons who remain infected and linking them to appropriate care and treatment.

Primary funding source: None.

MeSH terms

  • Adult
  • Female
  • Hepacivirus / isolation & purification
  • Hepatitis C Antibodies / blood
  • Hepatitis C, Chronic / epidemiology*
  • Humans
  • Male
  • Middle Aged
  • Nutrition Surveys
  • Prevalence
  • RNA, Viral / analysis
  • Risk Factors
  • Substance-Related Disorders / complications
  • Transfusion Reaction
  • United States / epidemiology
  • Young Adult


  • Hepatitis C Antibodies
  • RNA, Viral