Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC, Mailstop G-37, Atlanta, GA 30329. Email:
Am J Manag Care. 2019 Aug;25(8):369-374.
Chronic hepatitis C virus (HCV) infection is typically asymptomatic until severe liver disease occurs and even then can remain undiagnosed for some time; thus, screening and treatment of asymptomatic persons are needed to prevent poor outcomes. In a previous analysis of data from between 2006 and 2011, we found that 17% of newly diagnosed HCV infections in 4 large health systems were among persons with cirrhosis and/or end-stage liver disease, termed "late diagnosis." We sought to determine the proportion with late diagnosis during 2014-2016, after release of CDC baby boomer (1945-1965 birth cohort) testing guidelines in 2012.
The cohort was based on analysis of electronic health records and administrative data of about 2.7 million patients visiting the same healthcare systems during 2014-2016.
Among persons with newly diagnosed chronic HCV infection during 2014-2016, we analyzed data collected up to January 1, 2017.
Among 2695 patients with newly diagnosed HCV infection, 576 (21.4%) had late diagnosis. Most were born between 1945 and 1965 (n = 1613 [59.9%]), and among these, 27.6% had late diagnosis. Patients with versus without late diagnosis had equally lengthy prediagnosis observation in the health systems (mean and median, 9.1 and 9.1 vs 8.3 and 7.8 years, respectively) but were more likely to have a postdiagnosis hospitalization (32.5% vs 12.5%; P <.001) with greater number of hospital days (358.8 vs 78.5 per 100 person-years; P <.001).
More than one-fifth of patients with newly diagnosed HCV infection during 2014-2016-and more than a quarter of those born between 1945 and 1965-had late diagnosis despite many years of in-system care, an increase of 5 percentage points since 2006-2011, after the interim initiation of age-based screening recommendations. Our data highlight missed opportunities for diagnosis and therapeutic intervention before the onset of severe liver disease, which is associated with high cost and diminished outcomes.
慢性丙型肝炎病毒（HCV）感染通常在出现严重肝脏疾病之前无症状，即使在那时，也可能会有一段时间未被诊断出来；因此，需要对无症状者进行筛查和治疗，以预防不良后果。在 2006 年至 2011 年期间的数据的先前分析中，我们发现 4 个大型卫生系统中诊断的新 HCV 感染中有 17%发生在肝硬化和/或终末期肝病患者中，称为“晚期诊断”。我们试图确定 2012 年 CDC 婴儿潮一代（1945-1965 年出生队列）检测指南发布后 2014-2016 年期间的晚期诊断比例。
该队列基于对 2014-2016 年期间在同一医疗保健系统就诊的约 270 万名患者的电子健康记录和行政数据进行的分析。
在 2014-2016 年期间新诊断为慢性 HCV 感染的患者中，我们分析了截至 2017 年 1 月 1 日收集的数据。
在 2695 例新诊断的 HCV 感染患者中，有 576 例（21.4%）为晚期诊断。大多数患者出生于 1945 年至 1965 年之间（n=1613[59.9%]），其中 27.6%为晚期诊断。与无晚期诊断的患者相比，这些患者在卫生系统中的预诊断观察时间同样长（平均值和中位数分别为 9.1 年和 9.1 年与 8.3 年和 7.8 年），但更有可能在诊断后住院（32.5%比 12.5%；P<.001），住院天数更多（每 100 人年 358.8 天比 78.5 天；P<.001）。
尽管有多年的系统内护理，但在 2014-2016 年期间诊断为 HCV 感染的患者中，有超过五分之一的患者（1945 年至 1965 年之间出生的患者中超过四分之一）为晚期诊断，这比 2006-2011 年期间基于年龄的筛查建议开始以来增加了 5 个百分点。我们的数据突出了在严重肝脏疾病发作之前诊断和治疗干预的机会错失，这与高成本和预后不良有关。
