Cornett Julia Kang, Bodiwala Vimal, Razuk Victor, Shukla Devangi, Narayanan Navaneeth
Division of Infectious Diseases, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Department of Pharmacy Practice and Administration, Rutgers Ernest Mario School of Pharmacy, Piscataway, New Jersey.
Open Forum Infect Dis. 2018 Mar 26;5(4):ofy065. doi: 10.1093/ofid/ofy065. eCollection 2018 Apr.
Persons born between 1945 and 1965 account for an estimated 81% of those infected with hepatitis C virus (HCV) in the United States. However, up to 60% remain undiagnosed. Prior studies have reported HCV screening results from large urban emergency departments.
This is a retrospective cohort study of patients in the 1945-1965 birth cohort tested for HCV in a large emergency department (ED) in New Jersey from June 1, 2016, through December 31, 2016. The purpose was to report HCV antibody and viral load results of this testing program located in a small urban/suburban area and to analyze specific characteristics associated with positive results, such as race/ethnicity and insurance status. Descriptive statistics were performed, and, using a multivariate logistic regression model, adjusted odds ratios and 95% confidence intervals were calculated.
A total of 3046 patients were screened: 55.8% were white, and 17.9% were black; 52.1% had private insurance, 33.4% Medicare, 3.9% Medicaid. One hundred ninety-two were antibody positive (6.3%). Of 167 with HCV viral load testing results, 43% had a positive viral load. On multivariate analysis, black race and Medicaid were independently associated with a positive HCV viral load.
HCV antibody seropositivity was above 6% and twice as high as the Centers for Disease Control and Prevention estimated prevalence in this birth cohort. These results indicate that EDs outside of large urban cities are also important sites for routine HCV screening. Other findings of interest include 43% with chronic HCV infection and the persistent association between black race and positive HCV viral load even when adjusted for insurance status.
在美国，1945年至1965年间出生的人估计占丙型肝炎病毒（HCV）感染者的81%。然而，高达60%的人仍未被诊断出来。先前的研究报告了大型城市急诊科的HCV筛查结果。
这是一项回顾性队列研究，研究对象为2016年6月1日至2016年12月31日在新泽西州一家大型急诊科接受HCV检测的1945 - 1965年出生队列的患者。目的是报告位于小城区/郊区的该检测项目的HCV抗体和病毒载量结果，并分析与阳性结果相关的特定特征，如种族/民族和保险状况。进行了描述性统计，并使用多变量逻辑回归模型计算调整后的优势比和95%置信区间。
共筛查了3046名患者：55.8%为白人，17.9%为黑人；52.1%有私人保险，33.4%有医疗保险，3.9%有医疗补助。192人抗体呈阳性（6.3%）。在167名有HCV病毒载量检测结果的患者中，43%病毒载量呈阳性。多变量分析显示，黑人种族和医疗补助与HCV病毒载量阳性独立相关。
HCV抗体血清阳性率高于6%，是疾病控制与预防中心估计的该出生队列患病率的两倍。这些结果表明，大城市以外的急诊科也是进行常规HCV筛查的重要场所。其他有趣的发现包括43%的慢性HCV感染患者，以及即使在调整保险状况后，黑人种族与HCV病毒载量阳性之间仍存在持续关联。
