Read on to learn more about these differences — and why nearly everyone who’s diagnosed with hepatitis C today can be cured.

Chronic hepatitis C takes a greater toll on Black Americans

Black Americans account for about 13 percent of the U.S. population but 20 to 23 percent of diagnosed hepatitis C infections, according to a study published in January 2020 in the journal Hepatology Communications. “This disparity has been present and consistently shown since we as a field started measuring racial differences in hepatitis C infections,” says Heather Bradley, PhD, an epidemiologist with the Georgia State University School of Public Health who authored the 2020 report on hepatitis C infections by race. This could be due, in part, to Black Americans being more likely to have sickle cell disease, a red blood cell disorder that can require frequent blood transfusions. Because hepatitis C is transmitted through blood and the blood supply in U.S. blood banks wasn’t screened until 1992, this may partly explain why HCV infection was more common among older Black Americans, spokespeople from the Centers for Disease Control and Prevention (CDC) told Everyday Health. Blood transfusions used to be the most common cause of infection, says Coleman Smith, MD, a hepatologist with MedStar Georgetown University Hospital and member of the National Medical Advisory Committee for the American Liver Foundation. Since 1992, though, all blood has been thoroughly screened for viruses, including HCV. “Transfusions causing transmission of hepatitis C almost never occur,” says Dr. Smith.

Old hepatitis C treatments weren’t as effective in Black Americans, but new ones are

New direct-acting antiviral medications are extremely effective at curing HCV, have fewer side effects than older treatments, and seem to work equally well on people of all races, say CDC spokespeople. But it wasn’t always that way. Old HCV treatments using interferon were ineffective and caused many unbearable side effects. Research, including a study published in July 2011 in the journal Hepatology, also found that these drugs were significantly less likely to cure Black Americans than non-Black Americans. “Data showed that everyone responded poorly, but African Americans responded worse,” says Smith. A genetic variation, which is more common in African Americans, impacts how well people respond to old interferon-based treatments for hepatitis C infection. African Americans are also more likely to be infected with a specific strain of HCV (genotype 1), which is harder to treat with old HCV drugs, according to the 2011 study. The fact that older drugs were tested in white populations more often may partially explain why they also worked better in them. “There has been low representation of African Americans in clinical trials,” says Kimberly Forde, MD, PhD, an assistant professor of epidemiology and medicine at the Hospital of the University of Pennsylvania.

Black Americans may be less likely to receive HCV treatment

Some research, such as a study published in July 2017 in the journal Annals of Hepatology, suggests that African Americans were less likely to be treated for HCV than non-African Americans. Many barriers can block a person’s access to hepatitis C treatment, say CDC spokespeople, including lack of insurance coverage, less access to providers who treat hepatitis C, and Medicaid and Medicare restrictions. In the U.S., there’s a well-known wealth gap between races. Research from Brookings suggests that a white family’s net worth in 2016 was about 10 times that of a Black family. Black Americans are also roughly twice as likely to be uninsured or to be on Medicaid as non-Hispanic white Americans. “Treatment is expensive, and we rely very heavily on insurers to cover it,” says Smith. A study published in November 2019 in the Journal of Managed Care and Specialty Pharmacy suggests that disparity in treatment by race is narrowing, although differences remain based on socioeconomic status, notes Dr. Forde. One study, published in September 2018 in the American Journal of Gastroenterology, suggests that people on Medicaid were less likely to be treated for hepatitis C. Other research, published in July 2016 in the journal Clinical Gastroenterology and Hepatology, suggests that insurers deny nearly half of all HCV treatment claims to people on Medicaid. Old rules also denied HCV treatments to people who were currently using drugs. But a study published in July 2017 in the journal Annals of Hepatology suggests there’s no reason that African Americans should have been more likely to be deemed ineligible for these treatments due to risky behaviors, notes Forde. Recently, the rules have been significantly relaxed, she adds, so even people who continue to use IV drugs can receive hepatitis C treatments.

Hepatitis C is a leading cause of death among middle-aged Black Americans

Chronic liver disease and cirrhosis remain among the top 10 causes of death in African Americans ages 45 to 64, according to the CDC. Black Americans have also been statistically more likely to die of chronic hepatitis C than the general population. According to the U.S. Department of Health and Human Services Office of Minority Health, non-Hispanic Black Americans had been nearly twice as likely to die of hepatitis C as non-Hispanic white Americans. Today, with newer therapies, Black Americans are as likely to be cured as white Americans. “Given the disparity in rates of successful treatment of African Americans with chronic hepatitis C infection prior to the era of direct-acting antiviral therapy,” says Forde, “I suspect that the differences in mortality may have been due to our inability to cure infection, untreated or unknown infections, and other disparities in [the] care of African Americans.”

While chronic hepatitis C infection used to be highest among baby boomers (people born between 1946 and 1964) and Black Americans, studies such as a report published in February 2019 in the journal Digestive Diseases and Sciences now suggest that new infections are more common among people 20 to 39 years old. “Injection drug use has increased in the United States as a result of the opioid epidemic,” says Dr. Bradley. “Other drugs like methamphetamine are also increasingly injected.” The CDC’s most recent hepatitis C surveillance report further indicates a higher rate of acute hepatitis C infections among non-Hispanic white Americans compared with non-Hispanic Black Americans. But more data may be needed to understand these statistics nationwide. “Surveillance for hepatitis C is under resourced, and many acute hepatitis C infections are not reported to the CDC,” says Bradley. “Better and more complete surveillance data are needed to understand current trends in racial disparities.” At the same time, she adds, “Many of these factors have changed over time … so the same racial disparities may not be seen for new hepatitis C infections.” More than half of all people with HCV don’t know they’re infected, and new data suggests the disease affects people of all ages. This led the CDC to recently call for all adults to be screened for HCV at least once in their lives (more often if you use IV drugs). Serious health consequences of HCV may take decades to appear but can include chronic fatigue, kidney disease, diabetes, cirrhosis, liver failure, liver cancer, and even death, notes Forde. The good news is, modern hepatitis C treatments have a 95 to 99 percent cure rate in people of all races, says Forde. Plus, most insurers currently cover hepatitis C treatments with few restrictions, because ultimately, treating HCV early on costs less than letting it progress to a point where liver transplants or liver cancer treatments are necessary. “It’s a more cost-effective way of dealing with hepatitis C,” says Smith. So get tested for HCV, start treatment if your test comes back positive, and spread the word to family and friends. “With preventive strategies and effective treatments, we can cure the world of hepatitis C infection,” says Forde.