896 La Torre G et al. 3). The disease burden of hepatitis C is high. The World Health Organization (WHO) estimates that about 180 million people, 3% of the world population, are infected with HCV; of these, 130 million are chronic HCV carriers. Three to four million people are newly infected each year (2). Disease prevalence is low (< 1%) in Australia, Canada, and Northern Europe; it is approximately 1% in coun- tries of medium endemicity, such as the USA and most of Europe, and high (> 2%) in many countries in Africa, Latin America, and Central and Southeastern Asia. In these countries, the prevalence of HCV infection could increase to 10% (2). Currently, the majority of HCV infec- tions occur among adults, and injection drug use was the most common risk factor (4). At present, this infection is not eradicable, as a vacci- nation against hepatitis C is not yet available. Acquisi- tion of HCV infection typically involves the parenteral route (transfusions of blood or blood products from unscreened donors, injection drug use, or unsafe thera- peutic injections), but HCV can also be transmitted by occupational injury (contaminated needles or sharp in- struments), hemodialysis, and tattooing (5). Moreover, dental care was found to be associated with HCV sero- positivity (6). In addition, at least 50% of all HCV-positive patients do not have a history of blood transfusion or exposure to any other parenteral risk factor (7). In fact, familiar clustering of HCV infection has been demon- strated in epidemiological studies, but it is still contro- versial whether HCV can be transmitted to partners or other household contacts through horizontal transmis- sion (8, 9). Since the late 1980s, the incidence of acute hepatitis C has also declined. In particular, with regard to HCV cases associated with transfusion, this decrease could be attributed to the requirement for blood screen- ing worldwide (4). However, it is estimated that mortality related to HCV infection (death from liver failure or hepatocellular car- cinoma) will continue to increase over the next 2 decades (9). In Italy, the incidence of HCV has decreased from 5 per 100,000 in 1985 to 1 per 100,000 in 1996 (10). Mariano et al. (11), using mathematical modeling in order to esti- mate the HCV burden from 1950 to 2030, predicted that the number of individuals with HCV-related cirrhosis and HCV liver-related deaths will be halved by 2025. 2. Objectives The aim of this study was to estimate the trends of HCV infection in Italy in the period 1996–2006 for the whole population, as well as for gender and diﬀerent age groups, using the joinpoint regression method. 3. Materials and Methods Incidence rates of HCV infection (per 100,000) were cal- culated using data of cases of the integrated epidemio- logical system for acute viral hepatitis in Italy (SEIEVA) of the Italian Ministry of Health (12) and population data from the Health for All Database of the Italian National HCV Trends in Italy Institute of Statistics (ISTAT) (13), for the period 1996– 2006. Data regarding incidence rates were stratiﬁed by gender and age groups (in years: 0–14; 15–24; 25–64; ≥ 65). In Italy, a ministerial decree of December 15, 1990, states the mandatory registration of illnesses that could constitute an epidemiological risk. Since 1993, data on frequency of some infectious diseases (including HCV infections) were published by the Italian Ministry of Health in the Italian Epidemiology Bulletin (13). Data are shown by year and speciﬁc age group. ISTAT is a public and independent research organization that operates in continuous interaction with the academic and scientiﬁc communities. Since 1926, it is the main producer of oﬃ- cial statistics in Italy, available for citizens, researchers, and policy-makers. Data on the resident population are extrapolated from the registry oﬃce records of Italian municipalities. 3.1. Statistical Analysis Rates were computed as number of cases per general population, as previously described. In order to obtain time trends of HCV infection, the following formula (14) was applied for logarithmic transformation of incidence rates: ln (y) = b × x, Where “x” represents the calendar years, “b” is the re- gression coeﬃcient, and “y” the incidence rate. In par- ticular, a joinpoint represents the time point when a signiﬁcant trend change is detected. Time changes are expressed as expected annual percentage change (EAPC) with the respective 95% conﬁdence interval (95% CI); sig- niﬁcance levels of time trends are also reported. The hypothesis was tested using a maximum of 3 changes in slope with an overall signiﬁcance level of 0.05 divided by the number of joinpoints in the ﬁnal model. Linear graphs were created to represent trends. Statistical anal- ysis was conducted by using the joinpoint regression program software version 3.3.1. The Poisson model was applied to control heteroskedasticity in the population. 4. Results A total number of 6,806 cases of HCV infection occurred during the period 1996–2006, and a strong reduction in the incidence rates of HCV infection was observed in all age groups (Figure 1). In particular, in 1996, the highest incidence rate of HCV infection was found in subjects aged from 15 to 24 years (2.97 per 100,000), followed by the 25–64 years age group (2.16 per 100,000). In the pe- riod 1996–2006, the incidence rate decreased from 0.43 to 0.10 per 100,000 in the age group 0–14 years, from 2.97 to 0.66 in the group 15–24 years, from 2.16 to 0.67 in the age group 25–64 years, and from 2.11 to 0.41 in subjects aged 65 years or older. Considering all age groups, the incidence rate decreased from 2.02 to 0.55 per 100,000. Trend analysis showed a statistically signiﬁcant de- crease in the incidence rates of HCV infection in all age groups. The most remarkable decrease was noted among Hepat Mon. 2011;11(11):895-900