Section 3: Modelling the Incidence and Prevalence of Hepatitis C Infection and its Sequelae in Canada, 2007 – Results

3. Results

3.1 Actuarial model of HCV infection

The results of the modelling of HCV infection in Canada are presented in Tables 1 through 4.

Tables 1a, 1b and 1c present the estimated number of prevalent and incident HCV infections by place of birth, sex and exposure category in Canada in 2007. Overall, among 31,220,455 persons living in Canada as of December 2007, we estimated that 242,521 were infected with hepatitis C, for a prevalence rate of 0.78% or about one in 129 persons. Persons born in Canada accounted for 190,960 (79%) of these infections compared to 51,560 (21%) among immigrants. The HCV prevalence rate in persons born outside Canada was only slightly higher than that among persons born in Canada (0.80% compared to 0.77%). Sixty-one percent of prevalent HCV infections were among males, who had a prevalence rate 1.6-fold higher than females.

As expected, the majority of prevalent HCV infections were among IDUs. Current and ex-IDUs accounted for 139,964 (58%) of HCV-infected persons in Canada. Persons who were infected through the receipt of a blood transfusion accounted for 25,905 (11%) of HCV infections, hemophilia patients 861 (0.3%) and persons infected by other routes of transmission 75,790 (31%).

Tables 1a, 1b and 1c also present the estimated number of incident HCV infections by exposure category and sex in Canada in calendar year 2007 for all Canadian residents, persons born in Canada, and immigrants, respectively. Overall, we estimated that 7,945 persons in Canada were newly infected with HCV in 2007, for an overall incidence rate of 0.026% or about one in 3,900 persons. 5,185 (65%) of new HCV infections occurred in men, whose incidence rate was almost double that of women (0.034% compared to 0.018%). As expected, 83% of new HCV infections occurred in active IDUs.

Tables 1a, 1b and 1c include estimates of HIV prevalence and incidence. In our model, we estimated that 10,458 HCV-infected persons were also infected with HIV. This cannot be interpreted as an estimate of total HCV-HIV co-infection in Canada since HIV infection was included only to allow for competing mortality and therefore limited to IDU and hemophilia patients as described in Section 2.1. IDUs accounted for 98% of HCV-HIV co-infected persons in our model.

Table 1a - Modelled prevalence and incidence of HCV Infection and HCV/HIV co-infection by exposure category and sex among all persons, Canada, 2007

* Numbers may not add up exactly due to a combination of modelling uncertainities and the use of rounded whole numbers in the calculations

Note: A dash "-" indicates a category not included in the model

Sex Population Prevalence (Exposure category) Incidence (Exposure category)
HCV HIV co-infection HCV HIV co-infection
n rate n rate n rate n rate
IDU
Male 56,626 35,373 62.5% 3,765 6.6% 4,481 21.1% 571 1.1%
Female 27,735 17,139 61.8% 1,788 6.4% 2,126 20.1% 270 1.0%
Total* 84,361 52,512 62.2% 5,553 6.6% 6,607 20.7% 841 1.1%
Ex-IDU
Male 122,550 58,476 47.7% 3,178 2.6% 0 0.0% 0 0.0%
Female 61,290 28,977 47.3% 1,530 2.5% 0 0.0% 0 0.0%
Total* 183,839 87,452 47.6% 4,708 2.6% 0 0.0% 0 0.0%
Hemophilia
Male 2,162 861 39.8% 197 9.1% 0 0.0% 0 0.0%
Female 0 0 0.0% 0 0.0% 0 0.0% 0 0.0%
Total* 2,162 861 39.8% 197 9.1% 0 0.0% 0 0.0%
Transfused
Male 1,577,958 12,847 0.81% - -     1 0.000% - -    
Female 1,747,788 13,058 0.75% - -     1 0.000% - -    
Total* 3,325,746 25,905 0.78% - -     1 0.000% - -    
Other
Male 13,653,813 39,224 0.29% - -     704 0.005% - -    
Female 13,970,533 36,566 0.26% - -     633 0.005% - -    
Total* 27,624,347 75,790 0.27% - -     1,337 0.005% - -    
Total
Male 15,413,109 146,781 0.95% 7,140 0.046% 5,185 0.034% 571 0.0%
Female 15,807,346 95,740 0.61% 3,318 0.021% 2,760 0.018% 270 0.0%
Total* 31,220,455 242,521 0.78% 10,458 0.033% 7,945 0.026% 841 0.0%
Table 1b - Modelled prevalence and incidence of HCV Infection and HCV/HIV co-infection by exposure category and sex among persons born in Canada, Canada, 2007

* Numbers may not add up exactly due to a combination of modelling uncertainities and the use of rounded whole numbers in the calculations

Note: A dash "-" indicates a category not included in the model

Sex Population Prevalence (Exposure category) Incidence (Exposure category)
HCV HIV co-infection HCV HIV co-infection
n rate n rate n rate n rate
IDU
Male 49,735 31,388 63.1% 3,400 6.8% 3,945 21.5% 511 1.1%
Female 24,338 15,186 62.4% 1,611 6.6% 1,865 20.4% 241 1.1%
Total* 74,073 46,574 62.9% 5,011 6.8% 5,810 21.1% 751 1.1%
Ex-IDU
Male 107,678 51,902 48.2% 2,869 2.7% 0 0.0% 0 0.0%
Female 53,950 25,746 47.7% 1,379 2.6% 0 0.0% 0 0.0%
Total* 161,628 77,647 48.0% 4,248 2.6% 0 0.0% 0 0.0%
Hemophilia
Male 2,162 861 39.8% 197 9.1% 0 0.0% 0 0.0%
Female 0 0 0.0% 0 0.0% 0 0.0% 0 0.0%
Total* 2,162 861 39.8% 197 9.1% 0 0.0% 0 0.0%
Transfused
Male 1,247,010 10,599 0.85% - -     0.4 0.0% - -    
Female 1,353,113 10,775 0.80% - -     0.5 0.0% - -    
Total* 2,600,122 21,374 0.82% - -     0.9 0.0% - -    
Other
Male 10,918,419 23,457 0.21% - -     658 0.006% - -    
Female 11,027,878 21,048 0.19% - -     557 0.005% - -    
Total* 21,946,297 44,504 0.20% - -     1,215 0.006% - -    
Total
Male 12,325,003 118,207 0.96% 6,466 0.052% 4,604 0.038% 511 0.004%
Female 12,459,279 72,754 0.58% 2,990 0.024% 2,423 0.020% 241 0.002%
Total* 24,784,282 190,960 0.77% 9,456 0.038% 7,026 0.029% 751 0.003%

Table 1c - Modelled prevalence and incidence of HCV Infection and HCV/HIV co-infection by exposure category and sex among persons born outside Canada, Canada, 2007

* Numbers may not add up exactly due to a combination of modelling uncertainities and the use of rounded whole numbers in the calculations

Note: A dash "-" indicates a category not included in the model

Sex Population Prevalence (Exposure category) Incidence (Exposure category)
HCV HIV co-infection HCV HIV co-infection
n rate n rate n rate n rate
IDU
Male 6,891 3,984 57.8% 365 5.3% 535 18.4% 60 0.92%
Female 3,397 1,953 57.5% 177 5.2% 261 18.1% 29 0.91%
Total* 10,287 5,938 57.7% 542 5.3% 797 18.3% 89 0.92%
Ex-IDU
Male 14,871 6,574 44.2% 309 2.1% 0 0.0% 0 0.0%
Female 7,340 3,231 44.0% 151 2.1% 0 0.0% 0 0.0%
Total* 22,211 9,805 44.1% 460 2.1% 0 0.0% 0 0.0%
Hemophilia
Male 0 0 0.0% 0 0.0% 0 0.0% 0 0.0%
Female 0 0 0.0% 0 0.0% 0 0.0% 0 0.0%
Total* 0 0 0.0% 0 0.0% 0 0.0% 0 0.0%
Transfused
Male 330,949 2,248 0.68% - -     0 0.0% - -    
Female 394,675 2,283 0.58% - -     0 0.0% - -    
Total* 725,624 4,531 0.62% - -     0 0.0% - -    
Other
Male 2,735,395 15,768 0.58% - -     46 0.002% - -    
Female 2,942,655 15,518 0.53% - -     76 0.003% - -    
Total* 5,678,050 31,286 0.55% - -     122 0.002% - -    
Total
Male 3,088,105 28,574 0.93% 674 0.022% 582 0.019% 60 0.002%
Female 3,348,067 22,986 0.69% 328 0.010% 337 0.010% 29 0.001%
Total* 6,436,172 51,560 0.80% 1,002 0.016% 919 0.014% 89 0.001%

Tables 2a, 2b and 2c present the prevalence of HCV infection in Canada in 2007 by sex and age group for all Canadian residents, persons born in Canada, and immigrants, respectively. The pattern of HCV prevalence by age was somewhat different among those born in Canada than among immigrants. For persons born in Canada, HCV prevalence increased with increasing age to a peak of 1.37% in persons 55-59 years of age and then decreased thereafter. For persons born elsewhere, HCV prevalence increased with increasing age, attaining 2.15% in those 90+ years of age, the oldest age group. Overall, the HCV prevalence rate was 0.95% in males and 0.61% in females.

Table 2a - Modelled HCV prevalence by age group and sex among all persons, Canada, 2007

* Numbers may not add up exactly due to a combination of modelling uncertainities and the use of rounded whole numbers in the calculations

Age
(years)
Male Female Both sexes
Population HCV
number
HCV
rate
Population HCV
number
HCV
rate
Population HCV
number*
HCV
rate
0-4 883,789 36 0.004% 850,404 54 0.006% 1,734,193 89 0.005%
5-9 888,541 106 0.012% 854,537 149 0.017% 1,743,078 256 0.015%
10-14 1,020,302 186 0.018% 979,790 253 0.026% 2,000,091 439 0.022%
15-19 1,124,092 1,099 0.098% 1,082,505 752 0.069% 2,206,597 1,851 0.084%
20-24 1,091,925 4,420 0.40% 1,063,587 2,505 0.24% 2,155,512 6,925 0.32%
25-29 1,096,850 9,966 0.91% 1,090,286 5,500 0.50% 2,187,136 15,465 0.71%
30-34 1,079,204 13,822 1.28% 1,088,544 7,730 0.71% 2,167,748 21,552 0.99%
35-39 1,112,922 16,112 1.45% 1,130,875 9,319 0.82% 2,243,798 25,431 1.13%
40-44 1,248,603 17,864 1.43% 1,269,229 10,632 0.84% 2,517,832 28,496 1.13%
45-49 1,400,255 20,107 1.44% 1,427,374 12,354 0.87% 2,827,629 32,460 1.15%
50-54 1,298,141 19,196 1.48% 1,336,508 12,232 0.92% 2,634,649 31,428 1.19%
55-59 1,048,727 15,955 1.52% 1,098,456 10,602 0.97% 2,147,183 26,557 1.24%
60-64 807,019 12,033 1.49% 861,344 8,465 0.98% 1,668,363 20,498 1.23%
65-69 541,287 7,518 1.39% 598,454 5,839 0.98% 1,139,741 13,357 1.17%
70-74 361,043 4,418 1.22% 430,575 3,967 0.92% 791,618 8,385 1.06%
75-79 238,948 2,369 0.99% 324,150 2,621 0.81% 563,098 4,990 0.89%
80-84 118,654 998 0.84% 195,459 1,519 0.78% 314,113 2,517 0.80%
85-89 42,735 404 0.94% 91,554 840 0.92% 134,288 1,244 0.93%
90+ 10,071 172 1.71% 33,715 408 1.21% 43,786 580 1.33%
Total* 15,413,109 146,781 0.95% 15,807,346 95,740 0.61% 31,220,455 242,521 0.78%

Table 2b - Modelled HCV prevalence by age group and sex among persons born in Canada, Canada, 2007

*Numbers may not add up exactly due to a combination of modelling uncertainities and the use of rounded whole numbers in the calculations

Age
(years)
Male Female Both sexes
Population HCV
number
HCV
rate
Population HCV
number
HCV
rate
Population HCV
number*
HCV
rate
0-4 864,684 4 0.000% 830,727 3 0.000% 1,695,411 7 0.000%
5-9 833,279 10 0.001% 800,939 8 0.001% 1,634,219 18 0.001%
10-14 927,883 18 0.002% 892,550 15 0.002% 1,820,433 32 0.002%
15-19 993,638 811 0.082% 957,931 384 0.040% 1,951,569 1,195 0.061%
20-24 925,422 3,708 0.40% 896,501 1,852 0.21% 1,821,924 5,560 0.31%
25-29 901,281 8,460 0.94% 879,338 4,341 0.49% 1,780,619 12,801 0.72%
30-34 849,516 11,520 1.36% 835,708 6,064 0.73% 1,685,223 17,585 1.04%
35-39 843,433 13,134 1.56% 836,410 7,214 0.86% 1,679,843 20,348 1.21%
40-44 957,000 14,738 1.54% 956,860 8,434 0.88% 1,913,860 23,172 1.21%
45-49 1,056,494 16,564 1.57% 1,065,175 9,838 0.92% 2,121,669 26,402 1.24%
50-54 948,282 15,580 1.64% 967,158 9,586 0.99% 1,915,440 25,166 1.31%
55-59 748,060 12,767 1.71% 775,995 8,172 1.05% 1,524,055 20,939 1.37%
60-64 563,752 9,418 1.67% 596,692 6,375 1.07% 1,160,444 15,793 1.36%
65-69 364,918 5,585 1.53% 400,258 4,166 1.04% 765,176 9,751 1.27%
70-74 246,464 3,166 1.28% 292,606 2,743 0.94% 539,070 5,908 1.10%
75-79 173,044 1,677 0.97% 234,790 1,803 0.77% 407,834 3,480 0.85%
80-84 88,085 669 0.76% 144,859 989 0.68% 232,944 1,658 0.71%
85-89 32,440 268 0.83% 69,494 536 0.77% 101,934 804 0.79%
90+ 7,329 109 1.49% 25,288 231 0.91% 32,616 340 1.04%
Total* 12,325,003 118,207 0.96% 12,459,279 72,754 0.58% 24,784,282 190,960 0.77%

Table 2c - Modelled HCV prevalence by age group and sex among persons born outside Canada, Canada, 2007

*Numbers may not add up exactly due to a combination of modelling uncertainities and the use of rounded whole numbers in the calculations

Age
(years)
Male Female Both sexes
Population HCV
number
HCV
rate
Population HCV
number
HCV
rate
Population HCV
number*
HCV
rate
0-4 19,105 32 0.17% 19,676 50 0.26% 38,782 82 0.21%
5-9 55,262 96 0.17% 53,598 141 0.26% 108,860 237 0.22%
10-14 92,419 168 0.18% 87,240 238 0.27% 179,659 407 0.23%
15-19 130,454 288 0.22% 124,574 367 0.29% 255,028 656 0.26%
20-24 166,502 713 0.43% 167,086 653 0.39% 333,588 1,365 0.41%
25-29 195,569 1,506 0.77% 210,948 1,158 0.55% 406,517 2,664 0.66%
30-34 229,688 2,302 1.00% 252,836 1,666 0.66% 482,524 3,967 0.82%
35-39 269,490 2,978 1.11% 294,465 2,105 0.71% 563,955 5,083 0.90%
40-44 291,603 3,126 1.07% 312,369 2,198 0.70% 603,972 5,324 0.88%
45-49 343,761 3,542 1.03% 362,200 2,516 0.69% 705,960 6,058 0.86%
50-54 349,859 3,616 1.03% 369,350 2,646 0.72% 719,209 6,262 0.87%
55-59 300,667 3,188 1.06% 322,461 2,430 0.75% 623,127 5,618 0.90%
60-64 243,267 2,615 1.07% 264,652 2,090 0.79% 507,920 4,705 0.93%
65-69 176,369 1,933 1.10% 198,197 1,673 0.84% 374,566 3,606 0.96%
70-74 114,579 1,253 1.09% 137,969 1,224 0.89% 252,548 2,477 0.98%
75-79 65,904 692 1.05% 89,360 818 0.92% 155,264 1,510 0.97%
80-84 30,570 329 1.08% 50,600 530 1.05% 81,169 859 1.06%
85-89 10,295 135 1.32% 22,060 304 1.38% 32,355 440 1.36%
90+ 2,742 63 2.29% 8,427 178 2.11% 11,169 240 2.15%
Total* 3,088,105 28,574 0.93% 3,348,067 22,986 0.69% 6,436,172 51,560 0.80%

Tables 3a, 3b and 3c present the incidence of new HCV infection in Canada in 2007 by sex and age for all Canadian residents, persons born in Canada, and immigrants, respectively. HCV incidence was 2.1-fold higher among persons born in Canada than among immigrants. HCV incidence in males was about double that of females in both groups. However, the higher rate among persons born in Canada was observed for both males and females. In both groups and both sexes, the peak incidence of HCV infection was observed in persons 25-29 years of age. Men 25-29 years of age born in Canada had the highest incidence of any group defined by sex, age and place of birth, with an annual HCV infection rate of 0.159%, or one in 630.

Table 3a - Modelled HCV incidence by age group and sex among all persons, Canada, 2007

*Numbers may not add up exactly due to a combination of modelling uncertainities and the use of rounded whole numbers in the calculations

Age
(years)
Male Female Both sexes
HCV
 number
Rate HCV
 number
Rate HCV
 number*
Rate
0-4 1 0.000% 1 0.000% 3 0.000%
5-9 1 0.000% 1 0.000% 2 0.000%
10-14 2 0.000% 1 0.000% 3 0.000%
15-19 318 0.028% 147 0.014% 464 0.021%
20-24 976 0.090% 512 0.048% 1,488 0.069%
25-29 1,588 0.146% 809 0.075% 2,397 0.110%
30-34 1,185 0.111% 627 0.058% 1,812 0.084%
35-39 710 0.065% 402 0.036% 1,112 0.050%
40-44 231 0.019% 131 0.010% 362 0.015%
45-49 127 0.009% 83 0.006% 210 0.008%
50-54 17 0.001% 15 0.001% 32 0.001%
55-59 11 0.001% 11 0.001% 22 0.001%
60-64 8 0.001% 8 0.001% 16 0.001%
65-69 5 0.001% 5 0.001% 10 0.001%
70-74 3 0.001% 3 0.001% 6 0.001%
75-79 2 0.001% 2 0.001% 4 0.001%
80-84 1 0.001% 1 0.001% 2 0.001%
85-89 0 0.001% 1 0.001% 1 0.001%
90+ 0 0.001% 0 0.001% 0 0.001%
Total* 5,185 0.034% 2,760 0.018% 7,945 0.026%

Table 3b - Modelled HCV incidence by age group and sex among persons born in Canada, Canada, 2007

*Numbers may not add up exactly due to a combination of modelling uncertainities and the use of rounded whole numbers in the calculations

Age
(years)
Male Female Both sexes
HCV
 number
Rate HCV
 number
Rate HCV
 number*
Rate
0-4 1 0.000% 1 0.000% 3 0.000%
5-9 1 0.000% 1 0.000% 2 0.000%
10-14 1 0.000% 1 0.000% 3 0.000%
15-19 297 0.030% 138 0.014% 435 0.022%
20-24 895 0.097% 468 0.052% 1,363 0.075%
25-29 1,421 0.159% 718 0.082% 2,139 0.121%
30-34 1,036 0.124% 540 0.065% 1,576 0.095%
35-39 605 0.073% 337 0.041% 942 0.057%
40-44 195 0.021% 110 0.012% 305 0.016%
45-49 109 0.011% 70 0.007% 180 0.009%
50-54 15 0.002% 12 0.001% 27 0.001%
55-59 10 0.001% 9 0.001% 19 0.001%
60-64 7 0.001% 6 0.001% 13 0.001%
65-69 4 0.001% 4 0.001% 8 0.001%
70-74 2 0.001% 2 0.001% 5 0.001%
75-79 2 0.001% 2 0.001% 3 0.001%
80-84 1 0.001% 1 0.001% 2 0.001%
85-89 0 0.001% 1 0.001% 1 0.001%
90+ 0 0.001% 0 0.001% 0 0.001%
Total* 4,604 0.038% 2,423 0.020% 7,026 0.029%

Table 3c - Modelled HCV incidence by age group and sex among persons born outside Canada, Canada, 2007

*Numbers may not add up exactly due to a combination of modelling uncertainities and the use of rounded whole numbers in the calculations

Age
(years)
Male Female Both sexes
HCV
 number
Rate HCV
 number
Rate HCV
 number*
Rate
0-4 0 0.000% 0 0.000% 0 0.000%
5-9 0 0.000% 0 0.000% 0 0.000%
10-14 0 0.000% 0 0.000% 0 0.000%
15-19 21 0.016% 9 0.007% 30 0.012%
20-24 81 0.049% 44 0.026% 124 0.037%
25-29 167 0.086% 91 0.043% 258 0.064%
30-34 149 0.066% 86 0.034% 235 0.049%
35-39 105 0.039% 65 0.022% 170 0.030%
40-44 36 0.012% 22 0.007% 57 0.010%
45-49 18 0.005% 13 0.004% 31 0.004%
50-54 2 0.001% 3 0.001% 5 0.001%
55-59 1 0.000% 2 0.001% 3 0.000%
60-64 1 0.000% 1 0.001% 2 0.000%
65-69 1 0.000% 1 0.000% 2 0.000%
70-74 0 0.000% 1 0.000% 1 0.000%
75-79 0 0.000% 0 0.000% 1 0.000%
80-84 0 0.000% 0 0.000% 0 0.000%
85-89 0 0.000% 0 0.000% 0 0.000%
90+ 0 0.000% 0 0.000% 0 0.000%
Total* 582 0.019% 337 0.010% 919 0.014%

3.2 HCV prevalence by province/territory and exposure category

Tables 4a and 4b show the modelled HCV prevalence number and rate in Canada in 2007 by province/territory and exposure category. As seen in Table 4a, the HCV prevalence rate was highest in the Yukon Territories, followed by the Northwest Territories and British Columbia. Three provinces accounted for 80% of HCV infections in Canada, namely Ontario (42%), British Columbia (22%) and Quebec (16%). According to Table 4b, IDUs accounted for 54% to 70% of modelled HCV prevalent infections across provinces and territories.

Table 4a - Modelled* HCV prevalence by province/territory and exposure category, Canada, 2007

*The provincial and territorial estimates of HCV prevalence presented here are based on an interpolation from national estimates and may be subject to considerable uncertainty. Provincial/territorial data are definitive should a discrepancy exist

**Numbers may not add up exactly due to a combination of modelling uncertainities and the use of rounded whole numbers in the calculations

Source: Statistics Canada. Quarterly Demographic Estimates - October to December 2007, Preliminary. Catalogue no. 91-002-X, vol. 21, no. 4. March 2008

Province / Territory IDU Transfused Hemophilia Other Total** Rate
(per total population)
Population Dec 31, 2007
Current-IDU Ex-IDU Total IDU
British Columbia 11,238 18,715 29,952 5,388 102 17,811 53,254 1.21% 4,413,973
Alberta 4,884 8,133 13,017 2,798 81 8,185 24,081 0.69% 3,497,881
Saskatchewan 1,470 2,449 3,919 466 29 1,819 6,234 0.62% 1,006,644
Manitoba 2,100 3,498 5,599 648 33 2,122 8,401 0.70% 1,193,566
Ontario 21,793 36,293 58,085 11,476 328 32,969 102,858 0.80% 12,861,940
Quebec 8,664 14,430 23,094 3,963 215 10,232 37,505 0.49% 7,730,612
New Brunswick 630 1,049 1,680 311 22 455 2,467 0.33% 751,250
Nova Scotia 945 1,574 2,519 492 28 1,213 4,252 0.45% 935,573
PEI 158 262 420 26 4 152 602 0.43% 139,089
Newfoundland 158 262 420 52 16 152 640 0.13% 508,099
Yukon 263 437 700 130 1 379 1,209 3.87% 31,247
Nunavut 53 87 140 26 1 76 243 0.78% 31,142
NWT 158 262 420 130 1 227 778 1.83% 42,594
Canada Total** 52,512 87,452 139,964 25,905 861 75,790 242,521 0.73% 33,143,610

Table 4b - Modelled HCV prevalence (number and proportion) by province/territory
and by exposure category, Canada, 2007

1 Row percent

*The provincial and territorial estimates of HCV prevalence presented here are based on an interpolation from national estimates and may be subject to considerable uncertainity. Provincial/territorial data are definitive should a discrepancy exist.

**Numbers may not add up exactly due to a combination of modelling uncertainities and the use of rounded whole numbers in the calculations

Province / Territory IDU Transfused Hemophilia Other Total
Current-IDU Ex-IDU Total IDU
HCV
 number
% 1 HCV
 number
% 1 HCV
 number
% 1 HCV
 number
% 1 HCV
 number
% 1 HCV
 number
% 1 HCV
 number**
% 1
British Columbia 11,238 21.1% 18,715 35.1% 29,952 56.2% 5,388 10.1% 102 0.19% 17,811 33.4% 53,254 100%
Alberta 4,884 20.3% 8,133 33.8% 13,017 54.1% 2,798 11.6% 81 0.34% 8,185 34.0% 24,081 100%
Saskatchewan 1,470 23.6% 2,449 39.3% 3,919 62.9% 466 7.5% 29 0.47% 1,819 29.2% 6,234 100%
Manitoba 2,100 25.0% 3,498 41.6% 5,599 66.6% 648 7.7% 33 0.39% 2,122 25.3% 8,401 100%
Ontario 21,793 21.2% 36,293 35.3% 58,085 56.5% 11,476 11.2% 328 0.32% 32,969 32.1% 102,858 100%
Quebec 8,664 23.1% 14,430 38.5% 23,094 61.6% 3,963 10.6% 215 0.57% 10,232 27.3% 37,505 100%
New Brunswick 630 25.5% 1,049 42.5% 1,680 68.1% 311 12.6% 22 0.87% 455 18.4% 2,467 100%
Nova Scotia 945 22.2% 1,574 37.0% 2,519 59.3% 492 11.6% 28 0.65% 1,213 28.5% 4,252 100%
PEI 158 26.2% 262 43.6% 420 69.8% 26 4.3% 4 0.72% 152 25.2% 602 100%
Newfoundland 158 24.6% 262 41.0% 420 65.6% 52 8.1% 16 2.56% 152 23.7% 640 100%
Yukon 263 21.7% 437 36.2% 700 57.9% 130 10.7% 1 0.071% 379 31.3% 1,209 100%
Nunavut 53 21.7% 87 36.1% 140 57.7% 26 10.7% 1 0.35% 76 31.3% 243 100%
NWT 158 20.3% 262 33.7% 420 54.0% 130 16.7% 1 0.11% 227 29.2% 778 100%
Canada Total** 52,512 21.7% 87,452 36.1% 139,964 57.7% 25,905 10.7% 861 0.35% 75,790 31.3% 242,521 100%

 

3.3 HCV infections among Aboriginal persons

Table 5 presents the number and prevalence of HCV infection among Aboriginal persons in Canada as 2007. We estimated that 34,865 Aboriginal persons were HCV-infected, for a prevalence of 3.0% overall, 4.1% in men and 1.9% in women. It must be realized, however, that this estimate is more of a hypothesis than a conclusion, given the lack of representative data in this population (see Discussion below).

Table 5 - Modelled HCV infection in the Aboriginal population, Canada, 2007

*Numbers may not add up exactly due to a combination of modelling uncertainities and the use of rounded whole numbers in the calculations

Sex Population Proportion
IDU
Number
IDU
HCV-infected
IDU
HCV-infected
other
HCV-infected
total
HCV-infected
rate
Male 572,090 6.0% 34,325 20,595 2,689 23,284 4.1%
Female 600,695 2.4% 14,417 8,650 2,931 11,581 1.9%
Total* 1,172,785 4.2% 48,742 29,245 5,620 34,865 3.0%

HCV prevalence among IDUs
HCV prevalence among others

60%
0.5%

3.4 HCV prevalence among incarcerated persons

Table 6a presents the number and prevalence of HCV infection among incarcerated persons in Canada in 2005. In that year, 20,930 persons were incarcerated in provincial institutions and 12,582 in federal institutions in Canada. We estimated that, overall, 6,261 were HCV-infected, for a prevalence of 18.7%. HCV prevalence among prisoners who were IDU was 61.3% (6,158/10,054) and 0.44% (103/23,458) among others.

Table 6b presents the number and prevalence of HCV infection among incarcerated persons in Canada by federal versus provincial institution and geographic region. HCV prevalence was slightly higher in federal compared to provincial prisons. It must be realized, however, that this estimate is not precise given the lack of representative data in this population and differences in interpreting and reporting practices across the regions (see Discussion below). Slightly more than half (55%) of HCV-infected prisoners were incarcerated in Ontario or Quebec.

Table 6c presents the number and prevalence of HCV infection among incarcerated persons in Canada by IDU status and geographic region. The high relative rate of HCV infection among IDU versus non-IDU was consistent across the geographic regions of Canada.

Table 6a - Modelled HCV infection among incarcerated persons, Canada 2005

*Numbers may not add up exactly due to a combination of modelling uncertainities and the use of rounded whole numbers in the calculations

Provincial Federal Total
Prison population 20,930 12,582 33,512
Proportion prisoners with history of IDU 30%
In prison?   Active IDU ?
Yes No Total
Yes 10,054 23,458 33,512
No 90,000
Total 100,054
Proportion HCV positive Provincial Federal
IDU 56% 70%
Non-IDU 0.10% 1.0%
Federal prisoners HCV
positive
HCV
negative
Total*
IDU 2,642 1,132 3,775
Non-IDU 88 8,719 8,807
Total* 2,730 9,852 12,582
21.7% 78.3% 100.0%
Provincial prisoners IDU 3,516 2,763 6,279
Non-IDU 15 14,636 14,651
Total* 3,531 17,399 20,930
16.9% 83.1% 100.0%
All prisoners, Ontario IDU 6,158 3,895 10,054
Non-IDU 103 23,356 23,458
Total* 6,261 27,251 33,512
18.7% 81.3% 100.0%
  HCV prevalence  
IDU 61.3%
Non-IDU 0.44%
Total 18.7%
Table 6b - Modelled HCV prevalence among incarcerated persons by type of institution and region, Canada, 2005

*Numbers may not add up exactly due to a combination of modelling uncertainities and the use of rounded whole numbers in the calculations

Pacific Prairie Ontario Quebec Atlantic Canada*
Federal
Number 1,818 2,960 3,426 3,104 1,274 12,582
Prevalence no. 395 642 743 674 276 2,730
Prevalence rate 21.7% 21.7% 21.7% 21.7% 21.7% 21.7%
Provincial
Number 2,470 5,365 8,115 3,946 1,034 20,930
Prevalence no. 417 905 1,369 666 174 3,531
Prevalence rate 16.9% 16.9% 16.9% 16.9% 16.9% 16.9%
All prisoners*
Number 4,288 8,325 11,541 7,050 2,308 33,512
Prevalence no. 811 1,547 2,112 1,339 451 6,261
Prevalence rate 18.9% 18.6% 18.3% 19.0% 19.5% 18.7%
Table 6c - Modelled HCV prevalence among incarcerated persons by region and IDU vs non-IDU, Canada, 2005

*Numbers may not add up exactly due to a combination of modelling uncertainities and the use of rounded whole numbers in the calculations

Pacific Prairie Ontario Quebec Atlantic Canada*
IDUs
Number 1,286 2,498 3,462 2,115 692 10,054
Prevalence no. 797 1,523 2,083 1,315 441 6,158
Prevalence rate 61.9% 61.0% 60.2% 62.2% 63.7% 61.3%
Non-IDUs
Number 3,002 5,828 8,079 4,935 1,616 23,458
Prevalence no. 14 24 30 24 10 103
Prevalence rate 0.48% 0.42% 0.37% 0.50% 0.60% 0.44%
All prisoners*
Number 4,288 8,325 11,541 7,050 2,308 33,512
Prevalence no. 811 1,547 2,112 1,339 451 6,261
Prevalence rate 18.9% 18.6% 18.3% 19.0% 19.5% 18.7%

 

3.5 The sequelae of HCV infection

Table 7a presents the modelled incidence of sequelae of HCV infection in Canada from 1967 to 2027. In 2007, we estimated that 802 persons developed cirrhosis, 473 persons progressed to decompensated liver failure, 292 cases of hepatocellular carcinoma occurred and 134 persons received a liver transplant due to HCV infection. In all, 483 persons died of HCV-related causes in 2007. Sequelae estimated assumed that infection incidence and immigration trends were stable after 2007. Note also that projections from 2007 to 2027 do not take into account the possible impacts of treatment. According to our model, the incidence of cirrhosis increased from 1967 to 1992, was relatively stable at around 800 new cases annually from 1992 to 2012 and will decrease slightly in subsequent years. However, the incidence of more advanced sequelae appears to peak later and mortality due to HCV continues to increase over the study period. The number of deaths from all HCV-related causes is projected to increase from 483 in 2007 to 613 in 2027, an increase of 27%.

The time trend in incidence of HCV sequelae is graphically depicted in Figure 2.

Table 7a - Modelled incidence of HCV infection and sequelae by five-year interval, Canada, 1967-2027
Year HCV sequelae
Infections Cirrhosis Decomp HCC Transplant Decomp
deaths
HCC
deaths
Transplant
deaths
Total liver
deaths
1967 16,563 120 39 20 5 5 18 1 24
1972 21,724 262 66 35 10 9 30 3 43
1977 24,233 430 117 61 19 16 54 7 77
1982 24,834 591 180 96 31 26 87 12 125
1987 18,497 733 254 139 49 41 128 20 189
1992 9,486 792 333 187 70 60 175 32 266
1997 8,058 808 397 230 94 80 220 47 346
2002 7,899 809 441 265 115 99 257 65 419
2007 7,945 802 473 292 134 114 285 82 483
2012 8,135 787 489 310 149 127 306 101 534
2017 8,269 772 494 321 160 137 319 117 572
2022 8,166 756 492 326 167 142 325 132 599
2027 7,959 736 483 325 171 146 326 142 613

 

Figure 2 - Modelled incidence of HCV sequelae by five-year interval, Canada 1967-2027

Modelled incidence of HCV sequelae by five-year interval, Canada 1967-2027

Table 7b presents the modelled prevalence of sequelae of HCV infection in Canada from 1967 to 2027. This table presents the total number of persons living with each complication of HCV infection and, thus, the numbers are not mutually exclusive. In 2007, an estimated 15,814 persons were living with cirrhosis, 5,495 in decompensated liver failure, 338 persons diagnosed with hepatocellular carcinoma and 1,187 post-transplant patients. According to our model, the prevalence of all sequelae of HCV infection will continue to increase in the future. The most dramatic increase is observed among post-transplant patients, from 1,187 in 2007 to 1,976 in 2027, an increase of 66%.

Table 7b - Modelled prevalence of HCV infection and sequelae (not exclusive*) by five-year interval, Canada, 1967-2027

* Estimates are not mutually exclusive and include all persons in the category

Year HCV sequelae
Infection Cirrhosis Decomp HCC Transplant
1967 60,632 1,148 221 23 21
1972 117,726 2,054 410 39 50
1977 179,224 3,611 743 69 99
1982 232,945 5,605 1,252 109 181
1987 264,095 7,934 1,940 158 304
1992 263,878 10,477 2,799 215 474
1997 254,165 12,690 3,748 266 688
2002 246,682 14,421 4,666 305 933
2007 242,521 15,814 5,495 338 1,187
2012 239,134 16,755 6,186 360 1,430
2017 236,343 17,333 6,721 373 1,649
2022 232,684 17,592 7,101 378 1,833
2027 227,371 17,570 7,333 379 1,976

The data in Table 7b is graphically depicted in Figure 3.

Tables 7c presents the modelled prevalence of sequelae of HCV infection in Canada from 1967 to 2027 in mutually exclusive categories classified according to the most advanced sequela (i.e. transplant, farthest to the right in the table).

Figure 3 - Modelled prevalence§ (not exclusive*) of HCV sequelae by five-year interval, Canada, 1967-2027

Modelled prevalence§ (not exclusive*) of HCV sequelae by five-year interval, Canada 1967-2027

§ Estimates assume stable risk populations and HCV infection risks and do not adjust for treatment.
* Estimates are mutually exclusive and are classified according to the category furthest to the bottom.

Table 7c - Modelled prevalence of HCV infection and sequelae (exclusive * ) by five-year interval, Canada,

1967-2027
* Estimates are mutually exclusive and are classified according to the category furthest to the right in the table
Year HCV sequelae
Infection Cirrhosis Decomp HCC Transplant
1967 59,484 910 194 23 21
1972 115,672 1,615 350 39 50
1977 175,613 2,818 625 69 99
1982 227,340 4,276 1,039 109 181
1987 256,161 5,886 1,586 158 304
1992 253,401 7,536 2,252 215 474
1997 241,475 8,774 2,962 266 688
2002 232,261 9,571 3,612 305 933
2007 226,707 10,122 4,167 338 1,187
2012 222,379 10,366 4,599 360 1,430
2017 219,010 10,408 4,903 373 1,649
2022 215,092 10,289 5,092 378 1,833
2027 209,801 10,038 5,177 379 1,976

3.6 Reported cases of HCV in Canada

Hepatitis C was first made a reportable disease in some provinces in Canada in 1991. Almost all reports come from laboratory tests confirming the presence of HCV infection. Duplicates are removed at data entry at the public health units when the identifying information of a new case report matches perfectly or almost perfectly with a case previously entered. Case data is collected by provinces and territories in Canada and transmitted regularly to the Public Health Agency of Canada. Obvious duplicates are also identified and removed at the provincial and territorial level.

Table 8a presents the number of HCV cases reported in Canada from 1991 to 2007 that were reported to the Public Health Agency of Canada as of September 2008. Cumulatively, 212,782 cases were reported in Canada during this period. The data provided were missing cases from several jurisdictions in the early years following the licensing of the HCV test. This is unlikely due to lack of HCV testing but rather to delayed reportability or delayed reporting of cases to the Public Health Agency of Canada. To adjust for this, missing data from several provinces and one territory was imputed based on the proportion of cases in years when reporting appeared more complete.

Table 8b presents the adjusted number of hepatitis C cases reported in Canada from 1991 to 2007. Cumulatively, 221,198 cases were reported in Canada during this period. The number of reported cases peaked in 1998 when 20,280 HCV cases were reported. A decreasing trend has been observed since then; 12,007 new cases were reported in 2006 and 11,795 in 2007. Despite this decreasing trend, this large number of cases in recent years compared to the likely fewer than 2,000 incident cases reported in the year they occur suggests that a substantial proportion of reported cases are “prevalent” infections and the reservoir of undiagnosed infections is not close to being exhausted.

Table 8a - Number of HCV cases reported to the Public Health Agency of Canada by year of report and province/territory*, unadjusted, Canada, 1991-2007

*Reflects data reported to the Public Health Agency of Canada as of September 30, 2008. Variability may exist between data reported by the provinces/territories and the Public Health Agency of Canada. Provincial/territorial data are definitive should a discrepancy exist.

Year of
report
Province/Territory Total
British Columbia Alberta Saskatch-
ewan
Manitoba Ontario Quebec New Brunswick Nova Scotia PEI Newfound-
land
Yukon NWT Nuna-
vut
1991 316 19 25 - - - - - 2 - - - - 362
1992 936 44 74 - 1,721 1 - - 1 - - - - 2,777
1993 1,005 62 343 - 2,557 4 93 - 1 2 - - - 4,067
1994 1,902 61 556 - 3,628 2 62 - 3 19 10 - - 6,243
1995 4,648 102 583 - 7,318 2 143 - - 41 44 - - 12,881
1996 6,140 103 524 - 7,782 51 160 336 - 36 67 - - 15,199
1997 7,728 127 604 - 6,458 1,687 177 528 - 43 69 - - 17,421
1998 6,267 1,506 917 - 7,045 3,070 218 429 59 46 57 - - 19,614
1999 4,999 2,333 537 573 6,458 3,288 186 305 26 46 35 29 6 18,821
2000 4,385 2,123 720 505 5,755 3,671 211 254 11 43 45 29 6 17,758
2001 4,370 2,128 684 656 5,502 2,961 179 195 27 46 45 38 12 16,843
2002 4,533 1,862 735 449 5,390 2,422 149 257 38 39 44 33 6 15,957
2003 3,602 1,574 643 451 5,329 2,570 214 256 38 57 41 26 5 14,806
2004 3,061 1,504 807 423 5,265 2,928 202 242 31 78 24 37 5 14,607
2005 2,856 1,435 666 419 4,494 2,455 272 254 43 84 37 21 7 13,043
2006 2,853 1,183 595 320 4,221 2,242 140 259 33 100 38 20 3 12,007
2007 2,873 513 380 174 4,333 1,823 90 - 50 90 31 17 2 10,376
Total 62,474 16,679 9,393 3,970 83,256 29,177 2,496 3,315 363 770 587 250 52 212,782

 

Table 8b - Number of HCV cases reported to the Public Health Agency of Canada by year of report and province/territory, adjusted*, Canada, 1991-2007

*The provincial and territorial estimates of HCV prevalence presented here are based relative weights among the jurisdictions derived from years for which data on reported cases were available to the Public Health Agency of Canada as of September 30, 2008. Provincial/territorial data are definitive should a discrepancy exist.

Year of
report
Province/Territory Total
British Columbia Alberta Saskatch-
ewan
Manitoba Ontario Quebec New Brunswick Nova Scotia PEI Newfound-
land
Yukon NWT Nuna-
vut
1991 316 19 25 - - - - - 2 - - - - 362
1992 936 44 74 60 1,721 169 82 34 1 10 7 - - 3,138
1993 1,005 62 343 68 2,557 190 93 39 1 11 8 - - 4,377
1994 1,902 61 556 114 3,628 323 62 65 3 19 10 - - 6,743
1995 4,648 102 583 535 7,318 1,518 143 305 - 41 44 - - 15,237
1996 6,140 103 524 588 7,782 1,670 160 336 - 36 67 - - 17,406
1997 7,728 127 604 597 6,458 1,687 177 528 - 43 69 - - 18,018
1998 6,267 1,506 917 666 7,045 3,070 218 429 59 46 57 - - 20,280
1999 4,999 2,333 537 573 6,458 3,288 186 305 26 46 35 29 6 18,821
2000 4,385 2,123 720 505 5,755 3,671 211 254 11 43 45 29 6 17,758
2001 4,370 2,128 684 656 5,502 2,961 179 195 27 46 45 38 12 16,843
2002 4,533 1,862 735 449 5,390 2,422 149 257 38 39 44 33 6 15,957
2003 3,602 1,574 643 451 5,329 2,570 214 256 38 57 41 26 5 14,806
2004 3,061 1,504 807 423 5,265 2,928 202 242 31 78 24 37 5 14,607
2005 2,856 1,435 666 419 4,494 2,455 272 254 43 84 37 21 7 13,043
2006 2,853 1,183 595 320 4,221 2,242 140 259 33 100 38 20 3 12,007
2007 2,862 1,290 497 349 4,333 1,849 187 223 49 95 41 16 4 11,795
Total 62,463 17,456 9,510 6,773 83,256 33,013 2,675 3,981 362 794 612 249 54 221,198

 

Figure 4 shows graphically the annual number of reported HCV cases in Canada from 1991 to 2007.

Figure 4 - Number of reported HCV diagnoses by year, adjusted, Canada, 1991-2007

Number of reported HCV diagnoses by year, adjusted, Canada, 1991-2007

As noted in Section 2.12 above, we wished to estimate the number of diagnosed HCV-infected persons who were still alive as of end 2007 to compare to the number of modelled HCV-infected persons at that time. Table 8c presents the results of this calculation and the comparison. As seen in the third column of data from the left, 192,225 or 87% of the cumulatively diagnosed HCV-infected persons were still alive as of December 2007. Overall, we estimate that 79% of the modelled number of HCV-infected persons living in 2007 have been diagnosed. This varied considerably by province/territory and, with the exception of Nunavut, represented from 44% to 133% of the modelled number of HCV infections.

Table 8c - Comparison of modelled* with reported HCV cases surviving to 2007 by province/territory, Canada, 2007

*The provincial and territorial estimates of HCV prevalence presented here are based on an interpolation from national estimates and may be subject to considerable uncertainty.

Provincial/territorial data are definitive should a discrepancy exist.

Source: Statistics Canada. Quarterly Demographic Estimates - October to December 2007, Preliminary. Catalogue no. 91-002-X, vol. 21, no. 4. March 2008

Province / territory Modelled Cumulative
diagnosed
Cumulative diagnosed, surviving Proportion diagnosed Population Dec 31, 2007 Rate
surviving
British Columbia 53,254 62,463 53,736 101% 4,413,973 1.22
Alberta 24,081 17,456 15,666 65% 3,497,881 0.45
Saskatchewan 6,234 9,510 8,290 133% 1,006,644 0.82
Manitoba 8,401 6,773 5,889 70% 1,193,566 0.49
Ontario 102,858 83,256 71,811 70% 12,861,940 0.56
Quebec 37,505 33,013 29,179 78% 7,730,612 0.38
New Brunswick 2,467 2,675 2,344 95% 751,250 0.31
Nova Scotia 4,252 3,981 3,460 81% 935,573 0.37
PEI 602 362 329 55% 139,089 0.24
Newfoundland 640 794 713 112% 508,099 0.14
Yukon 1,209 612 532 44% 31,247 1.70
NWT 243 249 226 93% 31,142 0.73
Nunavut 778 54 49 6% 42,594 0.12
Canada 242,521 221,198 192,225 79% 33,143,610 0.58

 

Figure 5 shows a graph of the number and rate of persons living with HCV infection by province/territory.

Figure 5 - Prevalence* (number and rate) of surviving reported HCV cases by province/territory, Canada, December 2007

Prevalence* (number and rate) of surviving reported HCV cases by province / territory, Canada, December 2007

*The provincial and territorial estimates of HCV prevalence presented here are based on an interpolation from national estimates and may be subject to considerable uncertainty. Provincial/territorial data are definitive should a discrepancy exist.

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