National Progress Report 2025 Goal: Reduce reported rate* of hepatitis C-related deaths among American Indian and Alaska Native persons by ≥30%

Age-adjusted rate* of hepatitis C-related deaths† among American Indian and Alaska Native persons‡

Bar chart for years 2013-2023, charting age-adjusted rate per 100,000, starting at 10.79 in 2013, declining to 9.05 by 2018, and then projected downward to 7.17 by 2023.

Source: CDC, National Vital Statistics System (1)
*Rates are per 100,000 and age adjusted to the 2000 U.S. standard population.
†Cause of death is defined as the underlying cause of death or one of the multiple causes of death and is based on the International Classification of Disease, 10th Revision (ICD-10) codes B17.1 or B18.2 (2).
‡Excludes those reporting Hispanic or Latino origin.

Summary of Findings

Compared to the overall population (regardless of race), American Indians and Alaska Natives (AI/AN) had a much higher age-adjusted hepatitis C-related mortality rate in 2018 (3.72 vs. 9.05 per 100,000 population, respectively); however, the AI/AN rate decreased from 10.24 per 100,000 U.S. population in 2017 to 9.05 in 2018, below the 2018 target rate of 9.73.

Reduction needed to meet 2025 goal: A 20.8% reduction from the 2018 rate of hepatitis C-related deaths among AI/AN is needed to meet the 2025 goal of 7.17 deaths per 100,000.

This reduction can best be achieved by

  • Increasing the proportion of AI/AN tested for hepatitis C.
  • Increasing the proportion of AI/AN with hepatitis C who are referred for care and who receive appropriate treatment.
  • Developing trainings, technical assistance, and tools for primary-care and other health‑care providers to support implementation of hepatitis C testing and referral, specifically for AI/AN patients.
  • Using digital technology and telemedicine models to expand access to specialty health‑care providers to all populations, including AI/AN.
  • Develop and disseminate audience-friendly, educationally appropriate, culturally, and linguistically responsive hepatitis C education materials for AI/AN.
  • Implementing educational campaigns to encourage testing and dispel myths about who is at increased risk for hepatitis C virus (HCV) infection.

Technical Notes

Data Sources: CDC, National Vital Statistics System (NVSS)

Numerator: Number of death records among non-Hispanic AI/AN with a report of hepatitis C listed as the underlying or one of the multiple causes of death

Denominator: Total U.S. Census population of non-Hispanic AI/AN

Indicator Notes: (1) Death certificates are completed for all deaths registered in the United States. Information for death certificates is provided to funeral directors or cremation organizations by attending physicians, medical examiners, and coroners. Death certificates are filed in vital statistics offices within each state and the District of Columbia. Through the NVSS, information from death certificates is compiled by CDC to produce national multiple-cause-of-death data; causes of death are coded in accordance with the International Classification of Diseases, Tenth Revision. (2) National multiple-cause mortality data from NVSS were obtained and analyzed, and those death records with a report of hepatitis C (ICD-10: B17.1 or B18.2) listed as the underlying or one of the multiple (e.g., contributing) causes of death in the record were enumerated. Rates were calculated as the number of deaths among AI/AN who were U.S. residents in the 50 states and District of Columbia related to hepatitis C divided by the total U.S. Census population of AI/AN in these jurisdictions using the bridged-race postcensal estimates of the July 1 resident population. Rates were standardized to the age distribution of the 2000 U.S. standard population.

Goal Setting: The 2025 goal of 7.17 hepatitis C-related deaths among AI/AN per 100,000 U.S. population is consistent with CDC’s Division of Viral Hepatitis 2025 Strategic Plan. Annual targets assume a constant (linear) rate of change from the observed baseline (2017 data year) to the 2025 goal (2023 data year).

Limitations: Mortality data must be interpreted with caution due to the potential for misclassification of ICD-10 codes on the death record, underrepresentation of certain racial/ethnic populations in U.S. Census data and underreporting of viral hepatitis as a cause of death on death certificates.


  1. Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death 1999-2018 on CDC WONDER Online Database, released in 2020. Data are from the Multiple Cause of Death Files, 1999-2018, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at on Apr 22, 2020 1:19:00 PM
  2. World Health Organization. International Classification of Diseases, 10th Revision. Geneva: World Health Organization; 1998. Available at: