CATIE

The epidemiology of hepatitis C in Canada

This fact sheet provides a snapshot of the hepatitis C epidemic in Canada. All epidemiological information is approximate, based on the best available data. Most of the data in this fact sheet come from national hepatitis C surveillance and estimates data published by the Public Health Agency of Canada. More information can be found in the section “Where do these numbers come from?” at the end of the fact sheet.

What is hepatitis C?

Hepatitis C is a liver infection caused by the hepatitis C virus. About one in four people clear hepatitis C on their own (spontaneous clearance), and the others go on to develop chronic hepatitis C that will need treatment to be cured. Treatments are highly effective at curing hepatitis C.

If left untreated, the hepatitis C virus causes inflammation over time, destroying healthy liver cells and causing the liver to replace them with scar tissue. This happens in a process called fibrosis. Over time, more of the liver gets replaced with scar tissue until nearly all of the liver is scarred; this is called cirrhosis. Chronic hepatitis C infection is associated with an increased risk of liver cancer, liver failure and early death.

There is no vaccination available against hepatitis C and there is no lasting immunity to hepatitis C.

Why are certain populations disproportionately impacted by hepatitis C in Canada?

Hepatitis C can affect anyone, no matter their age, sex, gender, sexual orientation, race or ethnic origin. However, certain populations carry a disproportionate burden of hepatitis C in Canada. In Canada, the hepatitis C epidemic is concentrated in marginalized communities because of structural and social factors that create health inequities. These communities, sometimes called priority populations, include:

people who inject or use drugs
people with experience in the prison system
Indigenous peoples (First Nations, Inuit and Métis)
gay, bisexual and other men who have sex with men (gbMSM)
immigrants and newcomers from countries where hepatitis C is common

As well, adults in the 1945–1975 birth cohort are disproportionately affected by hepatitis C.

While these populations have higher rates of hepatitis C and carry a disproportionate burden of hepatitis C compared with the broader population, this does not mean that being a member of one of these populations is itself a risk factor for hepatitis C. Rather, the intersections of many factors and experiences over an individual’s lifetime can lead to increased risk among people within these populations. It is also important to recognize the strengths and protective factors that exist within each of these communities and to work to build on those strengths to support and enhance health and wellness.

What statistics are available in Canada to inform programming?

There are two main types of numbers available: hepatitis C estimates and hepatitis C surveillance data (reported hepatitis C diagnoses).

Hepatitis C estimates are developed by the Public Health Agency of Canada through statistical modelling, using a variety of data sources. There are two main types of estimates:

Incidence estimates tell us how many people got hepatitis C in a given year; some people may have been diagnosed in that year, and others may not have been.
Prevalence estimates tell us how many people have ever had hepatitis C and how many people are living with chronic hepatitis C.

Hepatitis C surveillance data are also published by the Public Health Agency of Canada and tell us how many people were diagnosed with hepatitis C in a given year. This information does not tell us when they got hepatitis C, just when the diagnosis was made. People may have had hepatitis C for many years before diagnosis.

How many new hepatitis C infections are there in Canada (incidence)?

According to the 2021 national hepatitis C estimates, there were 8,212 new hepatitis C infections. This means that 22 people acquired hepatitis C every day. The estimated incidence rate was 21.5 per 100,000 people. These data were broken down by birth cohort. Among the 8,212 new hepatitis C infections:

2,168 occurred in people born between 1945 and 1964
2,212 occurred in people born between 1965 and 1979
3,179 occurred in people born between 1980 and 1994
654 occurred in people born in 1995 or later

Hepatitis C infections have decreased fairly steadily since 2012, when there were an estimated 10,075 new infections.

How many people have ever had hepatitis C in Canada (prevalence)?

According to the 2021 national hepatitis C estimates, there were an estimated 378,000 people who had ever had hepatitis C. The prevalence rate was 0.99%, which means that for every 100 people in Canada, one person had ever had hepatitis C.

Hepatitis C does not affect all people in Canada equally. Certain populations are disproportionately affected:

Among people who currently inject drugs (in the past 12 months), an estimated 64,400 had ever had hepatitis C. The prevalence rate in this group was 64.2%, meaning nearly two out of every three people who inject drugs had ever had hepatitis C.

Among people who have ever injected drugs, an estimated 137,000 had ever had hepatitis C. The prevalence rate in this group was 35.4%, meaning more than one in three people who had ever injected drugs had ever had hepatitis C.

Among people incarcerated in provincial prisons, an estimated 2,700 had ever had hepatitis C. The prevalence rate in this group was 14.2%, meaning about one in seven people who were incarcerated in provincial prisons had ever had hepatitis C.

Among people incarcerated in federal prisons, an estimated 1,370 had ever had hepatitis C. The prevalence rate was 11.1%. In other words, roughly one in nine people who were incarcerated in federal prisons had ever had hepatitis C.

Among First Nations people, an estimated 84,000 had ever had hepatitis C. The prevalence rate was 8.0%, which means about one in 12 First Nations people had ever had hepatitis C.

Among immigrants from countries where hepatitis C is common, an estimated 51,500 had ever had hepatitis C. The prevalence rate in this group was 4.0%, meaning one in 25 immigrants from countries where hepatitis C is common had ever had hepatitis C.

Among gbMSM, an estimated 20,100 had ever had hepatitis C. The prevalence rate was 3.0%. In other words, about one in 33 gbMSM had ever had hepatitis C.

Among adults born between 1945 and 1975, an estimated 270,000 had ever had hepatitis C. The prevalence rate in this group was 1.9%, meaning nearly one out of every 50 adults born between 1945 and 1975 had ever had hepatitis C.

*As a person can belong to more than one priority population, these numbers total more than 378,000 people.

How many people have chronic hepatitis C in Canada (prevalence)?

According to the 2021 national hepatitis C estimates, 214,000 people were living with a chronic hepatitis C infection. The prevalence rate was 0.56%, which means that for every 1000 people in Canada, 5.6 had chronic hepatitis C. Hepatitis C does not affect all people in Canada equally. Certain populations are disproportionately affected:

Among people who currently inject drugs (in the past 12 months), an estimated 37,000 had chronic hepatitis C. The prevalence rate in this group was 36.9%. In other words, nearly two out of every five people who inject drugs had chronic hepatitis C.

Among people who have ever injected drugs, an estimated 70,100 had chronic hepatitis C. The prevalence rate in this group was 18.1%, which means that nearly one in five people who had ever injected drugs had chronic hepatitis C.

Among people incarcerated in provincial prisons, an estimated 957 had chronic hepatitis C. The prevalence rate in this group was 5.1%, meaning about one in 20 people who were incarcerated in provincial prisons had chronic hepatitis C.

Among people incarcerated in federal prisons, an estimated 396 had chronic hepatitis C. The prevalence rate was 3.2%. In other words, roughly one in 30 people who were incarcerated in federal prisons had chronic hepatitis C.

Among First Nations people, an estimated 34,300 had chronic hepatitis C. The prevalence rate was 3.3%, which means about one in 30 First Nations people had chronic hepatitis C.

Among immigrants from countries where hepatitis C is common, an estimated 28,100 had chronic hepatitis C. The prevalence rate in this group was 2.2%, meaning one in 45 immigrants from countries where hepatitis C is common had chronic hepatitis C.

Among gbMSM, an estimated 6,290 had chronic hepatitis C. The prevalence rate was 0.94%. In other words, about one in 100 gbMSM had chronic hepatitis C.

Among adults born between 1945 and 1975, an estimated 157,000 had chronic hepatitis C. The prevalence rate in this group was 1.1%, meaning one in every 90 adults born between 1945 and 1975 had chronic hepatitis C.

How many people with chronic hepatitis C in Canada are unaware (undiagnosed)?

According to the 2021 national hepatitis C estimates, among the 214,000 people with chronic hepatitis C, 41.5%, or roughly two in five people, were unaware of their infection. This means that 58.5% had been diagnosed. There are gaps in diagnosis across different populations:

Among people who currently inject drugs (in the past 12 months), an estimated 18,500 were unaware of their chronic hepatitis C infection. The proportion who were unaware in this group was 49.9%, meaning nearly half of all people who inject drugs were unaware.

Among people incarcerated in federal prisons, an estimated 129 were unaware of their chronic hepatitis C infection. The proportion who were unaware in this group was 32.7%, meaning roughly one in three people incarcerated in federal prisons were unaware.

Among adults born between 1945 and 1975, an estimated 45,200 were unaware of their chronic hepatitis C infection. The prevalence rate in this group was 28.9%, meaning roughly three in 10 adults born between 1945 and 1975 were unaware.

There were insufficient data for the Public Health Agency of Canada to estimate the number and proportion of people in other populations who were unaware of their infection.

How many people have been treated for hepatitis C?

According to the 2021 national hepatitis C estimates, 108,000 people with chronic hepatitis C had been treated between 2012 and 2021. From 2012 to 2018, the number of people initiating treatment increased steadily, rising from 4,370 in 2012 to a peak of 19,155 in 2018. This represented more than a fourfold increase over six years. This period was marked by year-over-year growth, with particularly sharp increases observed between 2014 and 2015 (from 5,147 to 11,138) and again from 2017 to 2018 (from 14,887 to 19,155). These coincided with the introduction of direct-acting antiretrovirals in 2014, the first broad access to treatment in 2015, the decreased cost of treatment in 2017 and the implementation of universal coverage in 2018. Beginning in 2019, the trend reversed, with the number of people starting treatment declining annually. By 2021, the number had decreased to 10,155. While the number of people starting treatment in 2021 was still more than double the number in 2012, the downward trend from the 2018 peak may partly be due to the impact of the COVID-19 pandemic on services.

Between 2015 and 2021, the estimated number of people treated each year was higher than the number of new infections each year.

How many people have died from hepatitis C?

According to the 2021 national hepatitis C estimates, hepatitis C was a contributing cause of death for 972 people. Between 2015 and 2021 the annual death rate attributed to hepatitis C decreased from 4.3 to 2.54 per 100,000.

Is Canada on track to eliminate hepatitis C?

The World Health Organization (WHO) has established a global health sector strategy to eliminate viral hepatitis, including hepatitis C, as a public health threat by 2030. Canada has joined countries around the world in committing to reach targets set for the years 2020, 2025 and 2030.

For 2025 there are eight specific targets for hepatitis C. Data are available to track Canada’s progress for four of these targets. Canada has achieved the targets for hepatitis C related deaths and screening of blood units; targets have not yet been met for new infections and the proportion of people diagnosed. Data are not available for the remaining four targets, which include the number of new infections among people who inject drugs, safe healthcare injections, needle and syringe distribution, and the proportion of people diagnosed and cured. Collecting data on these targets is essential to fully understand Canada’s progress and to identify where action is needed.

2025 targets	Target met in 2021
13 new hepatitis C infections per 100,000	Not met (21.47 per 100,000)
Three new hepatitis C infections per 100,000 among people who inject drugs	No data available
Three deaths from hepatitis C per 100,000	Met (2.5 per 100,000)
200 needles and syringes distributed for every person who injects drugs	No data available
100% of blood units screened for blood-borne diseases	Met (100% screened)
100% of healthcare injections are safe	No data available
60% of people living with hepatitis C are diagnosed	Not met (58.5% diagnosed)
50% of people living with hepatitis C are diagnosed and cured	No data available

How many people are newly diagnosed with hepatitis C?

According to the 2021 national hepatitis C surveillance data, there were 7,535 hepatitis C diagnoses in Canada. This means that for every 100,000 people in Canada, 19.7 people were diagnosed with hepatitis C. On the basis of limited data (as not all provinces and territories report infection status), 209 diagnoses were acute, 2,026 were chronic and 5,300 were unspecified.

The hepatitis C diagnosis rate increased from 2012 to 2018 (by 15.4%), then decreased from 2018 to 2020 (by 42.8%) and then increased slightly from 2020 to 2021 (by 1.5%).

Who is being diagnosed with hepatitis C?

According to 2021 national hepatitis C surveillance data:

Among those whose sex was known, more males than females were diagnosed: 62.4% of new hepatitis C diagnoses were among men and 37.6% were among women.
Males had a higher rate of hepatitis C diagnoses than females: the rate of hepatitis C diagnoses among males was 24.6 cases per 100,000 males and among females it was 14.7 cases per 100,000 females.
Among males, those aged 30 to 39 had the highest hepatitis C diagnosis rate at 44.5 cases per 100,000 males aged 30 to 39.
Among females, those aged 25 to 29 had the highest hepatitis C diagnosis rate at 33.5 cases per 100,000 females aged 25 to 29.

Where are hepatitis C diagnosis rates the highest?

According to 2021 national hepatitis C surveillance data, there were seven provinces with hepatitis C diagnosis rates above the national average of 19.7 cases per 100,000:

Manitoba (42.3 per 100,000)
Saskatchewan (38.3 per 100,000)
Newfoundland and Labrador (29.8 per 100,000)
Nova Scotia (27.6 per 100,000)
British Columbia (26.2 per 100,000)
New Brunswick (22.9 per 100,000)
Ontario (20.4 per 100,000)

Six provinces and territories had diagnosis rates below the national average:

Nunavut (17.6 per 100,000)
Prince Edward Island (16.4 per 100,000)
Alberta (14.7 per 100,000)
Quebec (9.4 per 100,000)
Yukon (too low to report)
Northwest Territories (too low to report)

How is Canada doing at reaching people who inject drugs with key services along the continuum of care?

According to a surveillance study conducted among people who inject drugs in Canada between 2017 and 2019:

64.2% had ever had hepatitis C in their lifetime (antibody positive).
36.9% had a current chronic hepatitis C infection (a positive result on an RNA test). Of these, 50.1% were aware of their current hepatitis C infection.
Among participants aware of their current hepatitis C infection, 48.5% had been linked to hepatitis C care, 10.6% had ever been on hepatitis C treatment and 3.8% were currently taking hepatitis C treatment.

Key definitions

Hepatitis C prevalence—The number of people with hepatitis C at a point in time or the number who have ever had hepatitis C at a point in time. Prevalence tells us how many people have hepatitis C or have ever had hepatitis C.

Hepatitis C incidence—The number of new hepatitis C infections in a defined period of time (usually a year). Incidence tells us how many people are getting hepatitis C.

Hepatitis C diagnosis—The number of new hepatitis C diagnoses in a defined period of time (usually a year). Hepatitis C diagnoses tell us how many people have been diagnosed within a certain time frame.

Where do these numbers come from?

All epidemiological information is approximate, based on the best available data. The information in this fact sheet comes from data supplied by the Public Health Agency of Canada, including hepatitis C estimates, hepatitis C surveillance data and the Tracks survey of people who inject drugs in Canada (population-specific surveillance study).

National estimates of hepatitis C prevalence and incidence

National hepatitis C estimates are produced by the Public Health Agency of Canada using statistical modelling that takes into account some of the limitations of surveillance data reported to the Public Health Agency of Canada. It also accounts for the number of people with hepatitis C who are undiagnosed and the number of people with hepatitis C who have died.

Hepatitis C diagnoses (routine hepatitis C surveillance)

Healthcare providers are required to report hepatitis C diagnoses to their local public health authorities. Each province and territory then compiles this information and provides it to the Public Health Agency of Canada. This information does not contain names or personal identifiers. Limited additional information is also collected and sent to the Public Health Agency of Canada (e.g., age and gender).

Population-specific surveillance

The Public Health Agency of Canada monitors trends in key populations through periodic cross-sectional surveys conducted at selected sites in Canada. Because these systems only recruit participants voluntarily and are conducted only in certain locations, the results do not represent all people who belong to each population in Canada.

The Tracks survey of people who inject drugs in Canada is the national surveillance system of people who inject drugs conducted by the Public Health Agency of Canada. Through this surveillance system, anonymous information is collected directly from people who inject drugs, using a questionnaire and a biological specimen sample for HIV and hepatitis C testing. Phase Four of this cross-sectional survey was administered at selected sites (typically needle and syringe programs) across Canada from 2017 to 2019.

References

Tarasuk J, Zhang J, Lemyre A et al. National findings from the Tracks survey of people who inject drugs in Canada, Phase 4, 2017–2019. Canada Communicable Disease Report. 2020;46(5):138-48. Available at: https://doi.org/10.14745/ccdr.v46i05a07
Public Health Agency of Canada. Hepatitis C in Canada: 2021 surveillance data update. Public Health Agency of Canada; 2023. Available at: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/hepatitis-c-canada-2021-surveillance-data-update.html
Public Health Agency of Canada. Viral hepatitis estimates among key populations in Canada, 2021 (infographic). Public Health Agency of Canada; 2025. Available at: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/viral-hepatitis-estimates-key-populations-2021.html
Public Health Agency of Canada. Canada’s progress towards eliminating viral hepatitis as a public health concern. Public Health Agency of Canada; 2025. Available at: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/progress-towards-eliminating-viral-hepatitis-threat-2021.html
Périnet S, Williams A, Campeau L et al. National hepatitis B and C estimates for 2021: Measuring Canada’s progress towards eliminating viral hepatitis as a public health concern. Canada Communicable Disease Report. 2025;51(6/7):223−37. Available at: https://doi.org/10.14745/ccdr.v51i67a02

Author(s): Challacombe L

Published: 2025

Reviewer: Dr. Peggy Millson