The communities with highest public health needs in the state of Massachusetts were identified by a geospatial study conducted at Tufts University School of Medicine, focused on both HIV/AIDS and hepatitis C that revealed great disparities in death rates related to race and ethnicity. The research, which results were published in the journal PLOS ONE, was based on geospatial techniques and aims to determine the hotspots for deaths associated with the two diseases.
The study revealed Hispanic and African American populations register HIV/AIDS- or Hepatitis C-related death rates five times higher compared to those of Caucasians and Asians. The researchers also found the rates were particularly high among those aged 45 to 65 years old. The communities where HIV/AIDS- or Hepatitis C-related deaths are notably higher are Springfield, Worcester, South Boston, the Merrimack Valley, and New Bedford.
In addition, the investigators discovered that in Massachusetts, 4,818 died of HIV/AIDS, and 2,913 of hepatitis C, during the ten-year research period. Where there was a slight increase in the number of deaths due to hepatitis C, there was a corresponding slight decrease in HIV/AIDS-related deaths. The largest hotspots of hepatitis C-related deaths were found in South Boston/Dorchester, New Bedford, Lawrence/Merrimack Valley, Springfield, Worcester, and Salem/Lynn/Peabody.
“Many neighborhoods and towns are affected by these intertwined epidemics, but some neighborhoods and municipalities have been hit particularly hard,” explained senior author Tom Stopka, Ph.D., who is an assistant professor of public health and community medicine at Tufts University School of Medicine. “While these specific communities are hardest hit now, hepatitis C has been increasing in young, nonurban, white, populations so preventing transmission – particularly because it often takes about 20 to 30 years for symptoms to show up – is paramount.”
“Comprehensive prevention should include health education, enhanced counseling and testing, linkage to care, and increased access to sterile syringes through syringe exchange programs and pharmacies. Expanded treatment is also essential, for both HIV and hepatitis C, to decrease transmission risks in local communities,” added Stopka.
To arrive at these numbers, the study gathered data from all death certificates in Massachusetts between 2002 and 2011, with HIV/AIDS or hepatitis C as the underlying or contributing cause of death. The research team aimed to overcome a limitation of other studies that had only considered one cause of death, and not its underlying or contributing causes. Therefore, they used population estimates to calculate mortality rates in every census tract across the state by race and age.
“I conducted this study to better highlight the enormous, yet preventable, disparities that exist in infectious disease mortality, especially in the case of AIDS and hepatitis C. By analyzing who is dying from these conditions, and where, we can figure out the best ways to organize a targeted response to improve health equity,” said the study’s first author, David Meyers, M.P.H., who is currently an analyst at the Harvard School of Public Health and conducted the research as part of his MPH degree program at Tufts University School of Medicine.
The researchers emphasized the importance of viewing HIV/AIDS and hepatitis C as epidemics as they pose a challenge to American public health officials and physicians, especially with the prevalence of hepatitis C among baby boomers. While everyone is susceptible to contracting the disease, more than 75% of adults infected are baby boomers. Hepatitis C has a tendency to remain asymptomatic for decades, but is known to progress to chronic hepatitis C, which can cause serious health problems such as liver cirrhosis.