Kaiser Permanente Georgia, Atlanta, GA 30305, USA.
Am J Manag Care. 2011;17(8):548-55.
BACKGROUND/OBJECTIVE: The Centers for Disease Control and Prevention recommends routine screening for the hepatitis C virus antibody (anti- HCV) among persons most likely to be infected. Little is known about anti-HCV screening and prevalence in routine practice settings. We studied anti-HCV screening rates, anti-HCV positivity, and demographic and risk factors associated with increased likelihood of anti-HCV screening or positivity in a managed care organization (MCO).
This was a retrospective observational study of 17-to-74-year-old MCO enrollees from 2000 to 2007 (N = 557,056; 1,949,499 enrollee years). The primary outcome measures were likelihood of anti-HCV screening and HCV positivity (both in the total population and among those screened). Independent variables were: birth cohort, gender, HCV risk factors, and socioeconomic status (SES) and race of residents' neighborhoods. Likelihood of each outcome as a function of the independent variables was estimated using logistic regression.
Over the 8-year period, 4.31% of the total population received anti-HCV screening; 0.22% had a positive HCV result. Among those screened, HCV positivity was 5.15%. HCV screening and positivity rates increased over time. Both likelihood of HCV screening and HCV positivity were highest (P <0.05) among persons born during 1945-1964, males, those with HCV risk factors, and residents of neighborhoods of lower SES or with higher percentages of African Americans.
Although HCV screening and detection improved in this MCO over an 8-year period, anti-HCV screening was lower than expected. Many persons at risk for HCV remained unscreened. Strategies for improving anti-HCV screening in routine practice are recommended for patients at increased risk.
背景/目的：美国疾病控制与预防中心（Centers for Disease Control and Prevention）建议在最有可能感染的人群中常规筛查丙型肝炎病毒抗体（抗-HCV）。关于常规实践环境中的抗-HCV 筛查和流行情况知之甚少。我们研究了在一家管理式医疗组织（managed care organization，MCO）中，抗-HCV 筛查率、抗-HCV 阳性率以及与抗-HCV 筛查或阳性率增加相关的人口统计学和危险因素。
这是一项回顾性观察性研究，纳入了 2000 年至 2007 年期间 17 至 74 岁的 MCO 参保人（N=557056；1949499 参保人年）。主要结局指标是抗-HCV 筛查和 HCV 阳性率（在总人群和筛查人群中）的可能性。自变量包括：出生队列、性别、HCV 危险因素以及居民社区的社会经济地位（socioeconomic status，SES）和种族。使用逻辑回归估计每个结局作为独立变量的可能性。
在 8 年期间，总人群中有 4.31%接受了抗-HCV 筛查；有 0.22%的人 HCV 检测结果呈阳性。在接受筛查的人群中，HCV 阳性率为 5.15%。HCV 筛查和阳性率随时间推移而增加。在出生于 1945-1964 年的人群、男性、有 HCV 危险因素以及 SES 较低或非裔美国人比例较高的社区的居民中（P<0.05），HCV 筛查和 HCV 阳性率均最高。
尽管在 8 年期间，该 MCO 中 HCV 筛查和检测有所改善，但抗-HCV 筛查率低于预期。许多有 HCV 风险的人仍未接受筛查。建议在常规实践中采取策略提高抗-HCV 筛查率，以增加高危人群的筛查。
