Comparison of persons who died of drug overdoses with and without evidence of hepatitis C, United States, 2019-2024.

BACKGROUND: Injection drug use is the most common risk factor for hepatitis C virus (HCV) infection. Despite decreases in injection drug use among overdose decedents during 2020-2022, reported cases of newly-acquired hepatitis C remained relatively stable. This analysis compares sociodemographic characteristics and circumstances among overdose decedents with and without evidence of hepatitis C to inform prevention. METHODS: CDC's State Unintentional Drug Overdose Reporting System (SUDORS) collects data on unintentional and undetermined intent drug overdose deaths, including HCV infection information. Percentages of overdose deaths during July 2019-December 2024 with sociodemographic characteristics, drugs involved, and circumstances were calculated by hepatitis C evidence (48 jurisdictions). To assess trends, the percentage of overdose deaths with hepatitis C evidence was calculated by 6-month period from July 2019 to December 2024 (30 consistently reporting jurisdictions). RESULTS: Among 328,754 decedents, compared to those without hepatitis C evidence (94.6%), those with hepatitis C evidence (5.4%) more often were aged ≥ 55 years (36.0% vs. 24.7%) and non-Hispanic White (75.9% vs. 63.9%), and had ≥ 1 recent touchpoint or potential intervention opportunity (e.g., mental health treatment, nonfatal overdose; 40.3% vs. 23.9%). The percentage with hepatitis C evidence increased from 5.3% during July-December 2019 to 7.2% during July-December 2024. CONCLUSIONS: Implementing community-based services to prevent infectious disease spread and overdose, accessible hepatitis C testing, linkage to substance use disorder treatment and curative hepatitis C treatment, and robust public health surveillance to identify populations for tailored prevention efforts might help address hepatitis C and drug use epidemics.