Increases in HCV among hospitalized children and the association with substance abuse

Background: Significant attention has been paid to nationwide increases in Hepatitis C virus (HCV) infections in adults driven by increased drug use, especially in Appalachian states. There have been few studies to define the current burden of HCV in children. To better understand the role of nationwide trends, we examined data on inpatient stays in children with HCV.

Methods: We examined hospitalizations in children using the Kids’ Inpatient Database (KID), a part of the Healthcare Cost and Utilization Project (HCUP). The KID contains patient- and hospital-level data across 44 states and more than 4,100 community hospitals in 3-year increments. We identified cases using ICD-9 codes for HCV infection (070.41, 070.44, 070.51, 070.54, 070.70, 070.71, V02.62) during 2006, 2009, and 2012. Non-parametric tests for trend were used to calculate trend statistics.

 

Results: From 2006-2012 nationally, the number of hospitalizations of children infected with HCV increased from 1328 to 1827, which represents a 30% growth in the prevalence of HCV (0.42 to 0.57 per 1000 admissions; p<0.001). The mean age of children hospitalized was 17.6±4.7 years. HCV cases among those 18-20 years represented 68% of the total HCV diagnoses, with an increase over the years sampled from 841 cases to 1291 cases (p<0.001 for trend). One-third were coded as having a substance use disorder; it was the primary diagnosis for 5.3% of the total sample, with the prevalence of substance use overall among children with HCV increasing from 27% in 2006 to 41% in 2012 (p<0.001). Appalachian states (WV, KY, TN) were all represented amongst states in the top 2 quartiles of inpatient pediatric HCV prevalence. (Figure).

Conclusion:

The increases of HCV in hospitalized children are largely in teenagers, highly associated with substance abuse and concentrated in Appalachian states where this has already been defined as a problem in adults. This inpatient analysis likely far underestimates the number of infected individuals, but the results strongly suggest that public health efforts to prevent and treat HCV will also need to include teenage patients.

Figure. Prevalence of HCV Cases per 1000 Admissions in Children (Data from 2009, last year available) - see attachment.