Rousseau Christine M, Ioannou George N, Todd-Stenberg Jeffrey A, Sloan Kevin L, Larson Meaghan F, Forsberg Christopher W, Dominitz Jason A
Northwest Health Services Research and Development Center of Excellence and the Northwest Hepatitis C Resource Center, VA Puget Sound Health Care System, Seattle, WA, USA.
Am J Public Health. 2008 May;98(5):846-52. doi: 10.2105/AJPH.2007.113225. Epub 2008 Apr 1.
We examined the association between race and hepatitis C virus (HCV) evaluation and treatment of veterans in the Northwest Network of the Department of Veterans Affairs (VA).
In our retrospective cohort study, we used medical records to determine antiviral treatment of 4263 HCV-infected patients from 8 VA medical centers. Secondary outcomes included specialty referrals, laboratory evaluation, viral genotype testing, and liver biopsy. Multiple logistic regression was used to adjust for clinical (measured through laboratory results and International Classification of Diseases, Ninth Revision, codes) and sociodemographic factors.
Blacks were less than half as likely as Whites to receive antiviral treatment (odds ratio [OR]=0.38; 95% confidence interval [CI]=0.23, 0.63). Both had similar odds of referral and liver biopsy. However, Blacks were significantly less likely to have complete laboratory evaluation (OR=0.67; 95% CI=0.52, 0.88) and viral genotype testing (OR=0.68; 95% CI=0.51, 0.90).
Race is associated with receipt of medical care for various medical conditions. Further investigation is warranted to help understand whether patient preference or provider bias may explain why HCV-infected Blacks were less likely to receive medical care than Whites.
我们研究了退伍军人事务部（VA）西北网络中种族与丙型肝炎病毒（HCV）评估及退伍军人治疗之间的关联。
在我们的回顾性队列研究中，我们使用医疗记录来确定来自8个VA医疗中心的4263名HCV感染患者的抗病毒治疗情况。次要结果包括专科转诊、实验室评估、病毒基因型检测和肝活检。使用多元逻辑回归来调整临床因素（通过实验室结果和国际疾病分类第九版编码衡量）和社会人口统计学因素。
黑人接受抗病毒治疗的可能性不到白人的一半（优势比[OR]=0.38；95%置信区间[CI]=0.23，0.63）。两者在转诊和肝活检方面的可能性相似。然而，黑人进行完整实验室评估的可能性显著较低（OR=0.67；95%CI=0.52，0.88），进行病毒基因型检测的可能性也显著较低（OR=0.68；95%CI=0.51，0.90）。
种族与各种医疗状况的医疗护理接受情况相关。有必要进行进一步调查，以帮助了解患者偏好或医疗服务提供者的偏见是否可以解释为什么HCV感染的黑人比白人接受医疗护理的可能性更低。
