Data Methods
HepVu visualizes data related to Hepatitis C in the U.S., including standardized state-level estimates of people living with Hepatitis C infection. These estimates were generated by researchers affiliated with the Emory University Coalition for Applied Modeling for Prevention (CAMP) project, including from the University of Albany and Georgia State University, and researchers from the Centers for Disease Control and Prevention (CDC). HepVu is led by Patrick Sullivan, Ph.D., Professor of Epidemiology and Co-Director of the CFAR Prevention Science Core. HepVu currently maps Hepatitis C prevalence and mortality data for all U.S. states and Hepatitis C mortality at the county-level. Hepatitis C prevalence maps at the state-level can be viewed overall while Hepatitis C mortality maps at the state-level can be viewed overall and by age group, race, and sex. At the county level HepVu displays Hepatitis C mortality which can be viewed overall and by age and two county- level opioid indicators: overdose mortality and opioid dispensing rate. HepVu also displays three state-level opioid indicators: overdose mortality rate, opioid dispensing rate, and pain reliever misuse prevalence. HepVu also displays estimated overall injection-involved overdose deaths data at the state level. Additional data comparisons include social determinants of health, such as poverty, high school education, and people without health insurance as well as maps on opioid indicators at the state and county level and Hepatitis C treatment restrictions such as fibrosis, sobriety, prescriber, and retreatment restrictions at the state level.
Other HepVu resources including state profile pages, blogs with viral hepatitis experts, and infographics provide supplementary visualizations and complement the data presented in the maps and existing surveillance reports. Downloadable resources include map images, infographic panels that can be used for presentations or other materials, and downloadable datasets.
Detailed below are HepVu’s data methods and sources.
Definitions
Hepatitis C Prevalence: The data reflect persons with a positive Hepatitis C virus (HCV) test and positive HCV RNA test.
Hepatitis C Mortality: The data reflect deaths among persons with acute viral hepatitis C or chronic viral hepatitis C as an underlying cause of death. The map title “Deaths related to Hepatitis C” has been used to encompass deaths of persons diagnosed with acute or chronic Hepatitis C.
Injection-Involved Overdose Deaths: The data reflect the percentage of overdose deaths that were estimated to be injection-involved.
Opioid Dispensing Rate: The data reflect the number of opioid prescriptions dispensed in the U.S. per 100 persons. A prescription is considered a pharmaceutical dispensed initially or as a refill.
Overdose Mortality Rate: The data reflect deaths of persons from narcotic overdose per 100,000 persons.
Pain Reliever Misuse Prevalence: The data reflect the percentage of persons who self-report indicators of misusing prescription psychotherapeutics (defined as use in any way not directed by a doctor) in the past year.
Fibrosis Restrictions: the data reflect states that restrict access to Hepatitis C treatment based on the disease severity. Fibrosis restrictions are based on the fibrosis score, or stage of liver damage (F1, F2, F3, or F4).
Substance Use Restrictions: the data (also called “Sobriety Restrictions”) reflect states that require a period of abstinence from drugs or alcohol prior to or during treatment or require providers to counsel their patients regarding drug or alcohol use. Sobriety restrictions are measured based on the following categories: no sobriety restrictions, sobriety screening and counseling, abstinence during treatment, 1 month sobriety, 3 months sobriety, 6 months sobriety, and 12 months sobriety.
Prescriber Restrictions: The data reflect states that restrict access to HCV treatment by requiring the prescription to be issued by or in consultation with a specialist, or by requiring prescriber training or certification.
Prior Authorization Restrictions: The data reflect states that have prior authorization requirements before providing access to HCV treatment.
Retreatment Restrictions: The data reflect states that impose retreatment restrictions for those seeking HCV retreatment that are more severe than the restrictions imposed on patients seeking initial treatment.
Data Source
Hepatitis C Prevalence Estimates:
State-level hepatitis C virus (HCV) prevalence estimates presented on HepVu were generated using a Bayesian spatial integrated abundance model to estimate the number and proportion of adults living with current HCV infection in 2017–2020. The model integrated six HCV-related data sources to account for differences in how infections are identified and reported across states. Estimates were anchored to a national HCV prevalence estimate for 2017–2020 and incorporated state-level differences in HCV risk factors, data source coverage, and geographic patterns. The analysis included adults aged 18 years and older in the 48 contiguous states and the District of Columbia (D.C.). Alaska and Hawaii were excluded because the model incorporated geographic relationships among neighboring jurisdictions. The model incorporated six HCV-related outcomes representing different, partially observed groups of people with current HCV infection during 2017–2020.
- Acute HCV surveillance cases: Annual counts of acute HCV cases reported through state and local surveillance systems to the Centers for Disease Control and Prevention (CDC). Acute cases were identified according to CDC/Council of State and Territorial Epidemiologists surveillance case definitions and represented newly identified infections with clinical or laboratory evidence of recent infection.
- Chronic HCV surveillance cases: Annual counts of chronic HCV cases reported through state and local surveillance systems to CDC. Cases were identified according to established surveillance case definitions using laboratory evidence of current or past HCV infection without evidence of acute disease.
- HCV-related deaths: Cumulative counts of deaths reported to the National Vital Statistics System (NVSS) during the study period. Deaths were classified as HCV-related when acute viral hepatitis C (ICD-10 code B17.1) or chronic viral hepatitis C (ICD-10 code B18.2) was recorded as an underlying or contributing cause of death.
- HCV infections identified in MarketScan administrative claims data: Cumulative counts of adults with evidence of HCV infection in the Merative MarketScan Commercial and Medicare databases. These databases contain de-identified healthcare claims data primarily from privately insured individuals, including Medicare-eligible retirees with employer-sponsored supplemental coverage. Evidence of HCV infection was identified through HCV diagnostic codes or National Drug Codes for direct-acting antiviral (DAA) treatment during the study period.
- New HCV diagnoses among Medicaid recipients: State-level counts of Medicaid recipients with a new HCV diagnosis, obtained from a previously published study. These data covered January 1, 2018, through June 30, 2019.
- DAA treatment among Medicaid recipients: Cumulative counts of Medicaid recipients who received DAA treatment during 2017–2020, obtained from a previously published study.
Researchers adapted a Bayesian spatial integrated abundance model, a statistical framework for estimating populations that cannot be directly observed using multiple data sources that capture different portions of the underlying population. The model integrated the six HCV-related outcomes to estimate the underlying number of adults with current HCV infection in each state. It accounted for differences in the likelihood that infections would be captured by each data source, as well as variation in HCV risk factors across states and geographic relationships among neighboring jurisdictions.
Two types of state-level covariates were incorporated into the model:
- Data source–specific covariates or factors associated with the likelihood that HCV infections would be identified in each data source. These included hepatitis surveillance funding and reporting completeness; characteristics of state medicolegal death investigation systems; MarketScan enrollment relative to the state adult population and demographic and socioeconomic characteristics; and Medicaid enrollment, age distribution, Medicaid expansion status, and DAA treatment policies.
- HCV prevalence covariates or factors associated with underlying differences in HCV risk across states. These included sociodemographic characteristics, indicators of structural vulnerability such as unsheltered homelessness and adult incarceration, and factors related to injection drug use–associated harms, including drug overdose deaths and treatment admissions reporting injection drug use.
The model incorporated spatial random effects to account for similarities in HCV prevalence and data source outcomes among geographically connected states. Bayesian Markov chain Monte Carlo methods were used to estimate model parameters. State-level prevalence estimates were summarized using posterior means, with 95% credible intervals calculated from the posterior distributions.
Additional details are available in Bradley, H., Yu, Y.-H., Li, L., Kapadia, S. N., Sullivan, P. S., & Hall, E. W. (2026). Estimating hepatitis C virus prevalence in US states and the District of Columbia, 2017–2020 [Preprint]. medRxiv. https://doi.org/10.64898/2026.09.29.26364309
Hepatitis C State Mortality Data
The state-level Hepatitis C mortality data presented on HepVu (single-year data from 2018-2023) were obtained from the Centers for Disease Control and Prevention (CDC) WONDER Online Database System and compiled by researchers at the Rollins School of Public Health at Emory University. The CDC WONDER data are collected using information from death certificates of all U.S. residents within the 50 states and D.C. Deaths of residents of other U.S. territories and fetal deaths are not included. Demographic, geographic, and cause-of-death information for each individual is recorded. Any records that included the ICD-10 code for acute viral hepatitis C (B17.1) or chronic viral hepatitis C (B18.2) as the underlying or multiple cause of death were used to identify deaths related to hepatitis C.
If the death count for any particular group/state is less than 10, data are suppressed and appear as gray on the maps. If the death count for any particular group/state is 10 or greater and less than 20, the rate generated from that count is considered unreliable.
Hepatitis C County Mortality Data
The county-level hepatitis C mortality data presented on HepVu (single-year data from 2000-2020) are estimates calculated by researcher Eric Hall, using data from the National Center for Health Statistics Detailed Multiple Cause of Death (2000-2020) using deaths that listed ICD-10 codes for acute viral hepatitis C (B17.1) and chronic viral hepatitis C (B18.2) as a multiple cause of death. National Center for Health Statistics bridged-race annual county-level were used for the population denominators. A Bayesian multivariate model space-time conditional autoregressive model was used to model the annual number of hepatitis C deaths. The modeled counts were aggregated to estimates overall and age-stratified (<40 years and 40+ years) age-standardized county-level hepatitis C death rates. Previously, estimates for 2005-2017 were published by Eric Hall, et. al., in a paper titled “County-Level Variation in Hepatitis C Virus Mortality and Trends in the United States, 2005-2017.” The same methods described in this paper were used to update the data for 2000-2020.
Injection-Involved Overdose Deaths Data
The 2000-2020 state-level injection-involved overdose deaths data available on HepVu were published by Eric Hall, et. al. Currently, results are available for single-year data from 2023. The methods used to calculate these estimates can be found in a paper titled “Estimated number of injection-involved overdose deaths in US States, 2000-2020” by Eric Hall et. al. Briefly, a stratified analysis was conducted that utilized data from drug treatment admissions to estimate the percentage of persons injecting by reported drug type, within demographic strata (race/ethnicity, sex, age group). Using this estimated percentage along with counts of overdose deaths from the National Vital Statistics System (NVSS), we estimated the number of persons that died from an injection-involved drug overdose death within each state and year. We then divided the estimated number of injection-involved overdose deaths by the total number of overdose deaths to obtain the percentage of overdose deaths that were injection-involved, for each state and year.
All analyses were limited to adults ≥18 years within 50 US states and District of Columbia.
If the annual number of treatment admissions that reported any of the five drug types was less than 50 within any state, the results for that state and year were suppressed. Additionally, if more than 15% of treatment admissions that reported a drug of interest were missing, the results for that state and year were suppressed.
County Opioid Indicators
There are two opioid indicators mapped on HepVu at the county level. The two indicators are overdose mortality rate in 2021 and opioid dispensing rate in 2023.
County-level data on drug overdose mortality were obtained from the CDC’s National Center for Health Statistics and National Vital Statistics System (NVSS). Data from NVSS classified drug overdose death using International Classification of Diseases, Tenth Revision codes: X40–X44 (unintentional), X60–X64 (suicide), X85 (homicide), or Y10–Y14 (undetermined intent).
The opioid dispensing rate data for 2023 for all U.S. counties were obtained from the CDC’s National Center for Injury Prevention and Control. CDC derived the data from the IQVIA Transactional Data Warehouse to obtain the number of opioid prescriptions dispensed in the U.S. via retail. Please see the full CDC report for more details.
State Opioid Indicators
There are three opioid indicators mapped on HepVu at the state level. The three indicators are overdose mortality rate in 2023, opioid dispensing rate in 2023, and pain reliever misuse prevalence in 2024.
State-specific data for overdose mortality rates were obtained from the CDC injury center and the NVSS. Deaths were classified using the International Classification of Diseases, Tenth Revision. Drug overdose deaths were identified using underlying cause-of-death codes X40–X44, X60–X64, X85, or Y10–Y14. Rates are age-adjusted using the 2023 U.S. standard population, except for age-specific crude rates. All rates are per 100,000 population.
The opioid dispensing rate data were obtained from the CDC injury center. The rates of opioid prescription dispensed per 100 persons by dosage, type, and state data were collected from U.S. Opioid Dispensing Rate Maps. CDC derived the data from the IQVIA Transactional Data Warehouse to obtain the number of opioid prescriptions dispensed in the U.S. via retail. Please see the full CDC injury center drug overdose website for more details.
Pain reliever misuse data were obtained from a report produced by the Substance Abuse and Mental Health Service Administration (SAMHSA). The data come from the NSDUH: Model-Based Estimated Prevalence For States Report. The data are collected in the National Survey on Drug Use and Health. Misuse was described as anyone 12 and older using a prescription psychotherapeutic drug in any way not directed by a doctor and does not include over-the-counter drugs. Please see the full SAMHSA report for more details.
Treatment Restriction Data
The treatment restriction data published on HepVu come from the Center for Health Law and Policy Innovation at Harvard Law School (CHLPI). CHLPI, in collaboration with the National Viral Hepatitis Roundtable (NVHR), evaluated the status of Hepatitis C treatment restrictions for each state in the United States. To find these data, CHLPI evaluated the Medicaid reimbursement criteria for available direct-acting antivirals (DAAs) in each state, Washington DC, and Puerto Rico. A survey form was sent to each state’s Medicaid officials requesting their coverage criteria for DAAs. If a state was unresponsive, then the state’s Medicaid website was searched for any publicly available information. If the data in the survey form conflicted with publicly available data, then it was resolved either by communicating with the Medicaid officials in that state or by consensus. Along with Medicaid fee-for-service programs, data was also evaluated from managed care organizations (MCOs).
Data Stratification
HepVu allows viewers to examine Hepatitis C state-level prevalence data at the overall state level for cases and percent cases. Hepatitis C mortality data is able to be examined at the overall state level for cases and rates, as well as stratified by age group, race/ethnicity, and sex. The county-level mortality data displays rates overall and by two age groups, under 40 and 40 and older. The state-level mortality data display age as three birth cohorts –<50 years, 50-74, and 75+. The state mortality data display race/ethnicity as non-Hispanic American Indian or Alaska Native, non-Hispanic Asian, non-Hispanic Black/African American, non-Hispanic Native Hawaiian or Pacific Islander, non-Hispanic White, Multiple Races, and Hispanic/Latinx. The state mortality data display sex as male or female.
Ranges/Legend Values
Range intervals were developed using the Jenks natural breaks classification method. This method groups data values into meaningful and distinct classes, with the goal of minimizing the variance within each class while maximizing the variance between classes. Zeros were excluded in the calculation of cut points for rates, cases, and percentages. This method is implemented each time data is updated to determine the most appropriate ranges for each map. In order to illustrate the variation in rates and case counts, values were developed specific to each demographic grouping (i.e., overall, and separately by sex, by race, and by age group). Values were also developed for each of the opioid indicators maps and the five social determinants of health data comparison maps (see section below for details). The treatment restrictions legends were developed based on the different values for each map.
Caution should be exercised when viewing and interpreting different maps because the scales change across the different demographic breakdowns and geographic levels.
Data Comparisons
Social determinants of health, opioid indicators, and Hepatitis C treatment restrictions are available as maps and their associated scales were developed using the same method described above. The five social determinants displayed include: poverty (percent of population living in poverty), high school education (percent of population without a high school degree or equivalent), median household income, income inequality (measured by the Gini Coefficient, a measure of income inequality where 0 reflects complete equality and 1 reflects complete inequality), and people < 65 years of age without health insurance (percent of population lacking health insurance). The three opioid indicators are overdose mortality rate, opioid dispensing rate, and pain reliever misuse prevalence. The five Hepatitis C treatment restrictions are fibrosis restrictions, substance use restrictions (also called sobriety restrictions), prescriber restrictions, prior authorization restrictions, and retreatment restrictions.
Downloadable Datasets
National data are available for download. The state data available are 2017-2020 Hepatitis C prevalence, single-year 2018-2023 Hepatitis C state mortality, 2023 overdose mortality rate, 2023 opioid dispensing rate, 2024 pain reliever misuse prevalence, 2024 social determinants of health, Hepatitis C 2017-2024 treatment restrictions, and 2000-2020 and 2023 injection-involved overdose deaths. At the county-level, single-year 2000-2020 Hepatitis C mortality data, 2021overdose mortality rate, and 2023 opioid dispensing rate are available for download.
The downloadable datasets may have suppressed/missing values for several reasons. Suppressed and/or missing data are represented as -1, -2, or -9 in the dataset and indicate the following:
-1: Data not shown because of a small number of deaths and/or a small population.
-2: Data not available for this jurisdiction.
-9: Data are missing.
Citation
Data, maps, and information from HepVu may be used, provided credit is given to HepVu and the Rollins School of Public Health at Emory University. Recommended citations:
Data Source: HepVu (hepvu.org). Emory University, Rollins School of Public Health.
Hepatitis C Prevalence Manuscript Source: https://www.medrxiv.org/content/10.64898/2026.09.29.26364309v1
Hepatitis C County Mortality Manuscript
Source: https://aasldpubs.onlinelibrary.wiley.com/doi/abs/10.1002/hep.31756
Data Sources
Hepatitis C and Opioid Data
| Data Element | Location on HepVu | Data Source | Anticipated Update Frequency on HepVu Website |
| Estimated Rates and Case Counts of People Living with Hepatitis C Overall, State Data | Maps; Downloadable Datasets; State Profile Pages | Bradley, H., Yu, Y.-H., Li, L., Kapadia, S. N., Sullivan, P. S., & Hall, E. W. (2026). Estimating hepatitis C virus prevalence in US states and the District of Columbia, 2017–2020 [Preprint]. medRxiv. https://doi.org/10.64898/2026.09.29.26364309 | When available |
| Rates and Case Counts of Hepatitis C Mortality, State Data | Maps; Downloadable Datasets; State Profile Pages | Centers for Disease Control and Prevention. National Center for Health Statistics. CDC WONDER Online Database. | Annually |
| Rates of Hepatitis C Mortality, County Data | Maps; Downloadable Datasets | County‐Level Variation in Hepatitis C Virus Mortality and Trends in the United States, 2000‐2020 | When Available |
| Rate of Opioid Dispensing, State Data | Maps; State Profile Pages; Downloadable Datasets | Centers for Disease Control and Prevention; U.S. Opioid Dispensing Rate Maps | When Available |
| Rate of Overdose Mortality, State Data | Maps; State Profile Pages; Downloadable Datasets | Centers for Disease Control and Prevention. National Vital Statistics System, CDC WONDER Online Database.
|
When Available |
| Percent of People Misusing Pain Relievers, State Data | Maps; State Profile Pages; Downloadable Datasets | Substance Abuse and Mental Health Services Administration; 2024 National Survey on Drug Use and Health | When Available |
| Rate of Opioid Dispensing, County Data | Maps; Downloadable Datasets | Centers for Disease Control and Prevention; U.S. Opioid Dispensing Rate Maps | When Available |
| Rate of Overdose Mortality, County Data | Maps; Downloadable Datasets | Centers for Disease Control and Prevention. National Vital Statistics System, National Center for Health Statistics. | When Available |
| Percentage of Injection-Involved Overdose Deaths | Maps; State Profile Pages; Downloadable Datasets | Hall, Eric, et al. “Estimated Number of Injection-Involved Overdose Deaths in US States From 2000 to 2020: Secondary Analysis of Surveillance Data.” JMIR Publications, 4 May 2024, publichealth.jmir.org/2024/1/e49527.
|
When Available |
Data Comparisons
| Data Element | Location on HepVu | Data Source | Anticipated Update Frequency on HepVu Website |
| Hepatitis C Treatment Restrictions, State Data | Maps; State Profile Pages; Downloadable Datasets | Center for Health Law and Policy Innovation at Harvard Law School (CHLPI) & National Viral Hepatitis Roundtable; Data Request, August 2024. | Annually |
| Poverty (Percent of population, all ages, living in poverty), State Data | Maps; State Profile Pages; Downloadable Datasets | U.S. Census Bureau, American Community Survey 5-Year Estimates, 2024, Table S1701: Poverty Status in the Past 12 Months | Annually |
| Educational Attainment (Percent of people aged 25 and over without a high school diploma or equivalent), State Data | Maps; State Profile Pages; Downloadable Datasets | U.S. Census Bureau, American Community Survey 5-Year Estimates, 2024, Table S1501: Educational Attainment | Annually |
| Median Household Income, State Data | Maps; State Profile Pages; Downloadable Datasets | U.S. Census Bureau, American Community Survey 5-Year Estimates, 2024, Table S1903: Median Income in the Past 12 Months | Annually |
| Percent of population under age 65 lacking health insurance, State Data | Maps; State Profile Pages; Downloadable Datasets | U.S. Census Bureau, American Community Survey 5-Year Estimates, 2024, Table 2701: Selected Characteristics of Health Insurance Coverage in the United States | Annually |
| Gini Coefficient of income inequality, State Data | Maps; State Profile Pages; Downloadable Datasets | U.S. Census Bureau, American Community Survey 5-Year Estimates, 2024, Table B19083: Gini Index of Income Inequality | Annually |
| Population and Racial/Ethnic Make-Up | State Profile Pages | U.S. Census Bureau, American Community Survey 5-Year Estimates, 2024, Table DP05 (ACS Demographic and Housing Estimates) and Table S0101 (Age and Sex) | Annually |
