Manjelievskaia Janna, Brown Derek, Shriver Craig D, Zhu Kangmin
1 John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Rockville, MD, USA.
2 Uniformed Services University, Bethesda, MD, USA.
Public Health Rep. 2017 Sep/Oct;132(5):579-584. doi: 10.1177/0033354917719446. Epub 2017 Aug 2.
Chronic hepatitis C virus (HCV) is the most common blood-borne infection in the United States, with an estimated 2.7 to 3.9 million cases as of 2014. In August 2012, the Centers for Disease Control and Prevention (CDC) recommended 1-time HCV testing of all baby boomers. The objectives of this study were to (1) determine the proportion of people screened for HCV in the US Department of Defense Military Health System before and after the CDC screening recommendation for baby boomers and (2) assess whether certain patient or system factors were associated with screening for HCV before and after August 2012.
We used a dataset containing 5% of beneficiaries randomly selected from the Military Health System Data Repository medical claims database for the period July 2011 through September 2013.
Of 108 223 people eligible for HCV screening during the first period (July 2011 through July 2012), 1812 (1.7%) were screened. Of 109 768 people eligible during the second period (September 2012 through September 2013), 2599 (2.4%) were screened. HCV screening receipt was related to benefit type (Prime before August 2012: adjusted odds ratio [aOR] = 2.16; 95% confidence interval [CI], 1.89-2.46; Prime after August 2012: aOR = 1.93; 95% CI, 1.73-2.16) and care source (direct care before August 2012: aOR = 1.80; 95% CI, 1.57-2.07; direct care after August 2012: aOR = 2.45; 95% CI, 2.18-2.75); male sex (aOR = 1.17; 95% CI, 1.06-1.29) and black race (aOR = 1.20; 95% CI, 1.05-1.37) were associated with HCV testing only before August 2012.
Interventions should be implemented to increase awareness and knowledge of the current national HCV testing recommendation among baby boomers to seek out testing and health care providers to perform screening.
慢性丙型肝炎病毒(HCV)感染是美国最常见的血源性感染,截至2014年估计有270万至390万例。2012年8月,美国疾病控制与预防中心(CDC)建议对所有婴儿潮一代进行一次HCV检测。本研究的目的是:(1)确定在CDC针对婴儿潮一代的筛查建议发布前后,美国国防部军事卫生系统中接受HCV筛查的人员比例;(2)评估2012年8月前后,某些患者或系统因素是否与HCV筛查相关。
我们使用了一个数据集,该数据集包含从军事卫生系统数据存储库医疗理赔数据库中随机抽取的5%的受益者数据,时间跨度为2011年7月至2013年9月。
在第一阶段(2011年7月至2012年7月)符合HCV筛查条件的108223人中,有1812人(1.7%)接受了筛查。在第二阶段(2012年9月至2013年9月)符合条件的109768人中,有2599人(2.4%)接受了筛查。接受HCV筛查与受益类型(2012年8月前的Prime:调整后的优势比[aOR]=2.16;95%置信区间[CI],1.89 - 2.46;2012年8月后的Prime:aOR = 1.93;95% CI,1.73 - 2.16)和护理来源(2012年8月前的直接护理:aOR = 1.80;95% CI,1.57 - 2.07;2012年8月后的直接护理:aOR = 2.45;95% CI,2.18 - 2.75)有关;男性(aOR = 1.17;95% CI,1.06 - 1.29)和黑人种族(aOR = 1.20;95% CI,1.05 - 1.37)仅在2012年8月前与HCV检测相关。
应实施干预措施,以提高婴儿潮一代对当前国家HCV检测建议的认识和了解,促使他们主动寻求检测,并让医疗服务提供者进行筛查。