Epidemiology of hepatitis C in Alberta, Saskatchewan, and Manitoba compared to Canada, 1980-2023

Canada aims to eliminate hepatitis C (HCV) by 2030. While national rates have dropped, regional disparities persist. In 2021, Manitoba had the highest new HCV rates, and Saskatchewan's rates were double the national average. This study aimed to describe the incidence and risk factors associated with HCV infections in Alberta, Saskatchewan, and Manitoba, compared to Canada,1980-2023.

This ecological study used publicly available government reports from Alberta, Saskatchewan, Manitoba, and Canada (1980-2023) on HCV cases and rates by year and disaggregated by sex (female/male), age, ethnicity, province, sexual orientation (gay/bisexual men who have sex with men, heterosexual), and risk factors (injection drug use, blood products, and history of incarceration).

Since becoming nationally notifiable in 1991, HCV incidence in Canada has declined, but Saskatchewan has reported consistently rates above the national average since 2005. Manitoba's incidence rose, peaking in 2018, with the highest national rate in 2021 (42.8/100,000), while Alberta had the lowest rate (14.5/100,00 people). Males represented 61 % of HCV cases in Canada in 2022, but the sex gap is narrowing, particularly in the Prairies. Most cases in Canada occur among individuals aged 40-59, but younger groups (20-39) are increasingly affected in the Prairies, particularly females of childbearing age and males aged 30-39. Injection drug use was the leading risk factor in Saskatchewan and Manitoba.

Canada is on a downward trend in rates of HCV; however, Manitoba and Saskatchewan have higher rates, possibly due to syndemics of substance use, which are leading to increased rates of HIV and STBBIs. A collaborative effort in surveillance, testing, treatment, and prevention of HCV across the three provinces is necessary.