Estimating and comparing the burden of chronic Hepatitis C in the immigrant and the non-immigrant population in Québec
Bibliographic record
Abstract
Background: Immigrants have higher mortality from chronic viral hepatitis and hepatocellular carcinoma as compared to those born in Canada. Approximately 20% of this burden is likely due to hepatitis C (HCV). Despite this disparity there are no screening programs to detect chronic HCV in immigrants after arrival in Canada. This is partly due to a lack of population-based data describing the burden of chronic HCV in immigrants.Methods: To fill this gap, we created a case series of all cases of chronic hepatitis C reported from 1991-2008 in Québec through linking the MADO (Québec Reportable Disease) database to 5 other Québec administrative databases; the MICC (Québec Landed Immigrants), the RAMQ (Québec provincial health insurance and physician billing) and the hospitalization databases. Reported rates were estimated using the reported number of cases in immigrants and non-immigrants during the study period. Québec census data from 1991, 1996, 2001, and 2006 (stratified by immigrant and non-immigrant status) was used for the denominator. Rates, rate ratios, and 95% CIS were calculated using the Poisson distribution. Proportions of cases with chronic hepatitis C associated complications were calculated and compared in immigrants and non-immigrants. Results: A total of 20,459 cases of chronic hepatitis C (1,980 immigrants and 18,479 non-immigrants) were reported between 1998-2007. Cases from 1991-1997 were excluded due to incomplete laboratory reporting during this period. Immigrant cases were older (mean age 47.1 vs. 43.1 years, p < 0.0001) and were less likely to be male (53.1% vs. 68.2%, p <0.0001). The overall rate of chronic hepatitis C was similar for immigrants and non-immigrants [rates/100,000 (95%CI) were 25.2 (24.1-26.4) vs. 27.8 (27.4-28.2), rate ratio= 0.91]. Immigrants from several world regions however had higher rates of chronic hepatitis C as compared to the non-immigrant population; Eastern Europe/Central Asia [77.6 (68.2-87.0) rate ratio = 2.8], Sub-Saharan Africa [60.2 (51.5-68.8), rate ratio = 2.2], South Asia [48.1 (41.5-54.7), rate ratio = 1.7]. Immigrants had a higher proportion of compensated cirrhosis (15.1% vs. 12.9%, p= 0.007) and hepatocellular carcinoma (1.2% vs. 0.6%, p= 0.005) compared to non-immigrantsConclusions: Immigrants from several world regions are at increased risk for chronic hepatitis C, have a higher proportion of hepatitis C related complications and are diagnosed a mean of > 8 years after arrival in Canada. Many immigrants would therefore benefit from early screening and appropriately timed treatment for chronic hepatitis C to decrease associated morbidity and mortality.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".