直接作用抗病毒药物的使用与伴有痴呆和慢性丙型肝炎的医疗保险受益人的生存。
Use of Direct-Acting Antiviral Agents and Survival Among Medicare Beneficiaries with Dementia and Chronic Hepatitis C.
机构信息
Department of Health Policy and Administration, College of Health and Human Development, Pennsylvania, State University, University Park, PA, USA.
Department of Family Medicine and Community Health, School of Medicine, University of Minnesota, Minneapolis, MN, USA.
出版信息
J Alzheimers Dis. 2021;79(1):71-83. doi: 10.3233/JAD-200949.
BACKGROUND
Many patients with Alzheimer's disease and related dementia (ADRD) have chronic hepatitis C due to the high prevalence of both conditions among elderly populations. Direct-acting antivirals (DAAs) are effective in treating hepatitis C virus (HCV). However, the complexity of ADRD care may affect DAA use and outcomes among patients with HCV and ADRD. Little information exists on uptake of DAAs, factors associated with DAA use, and health benefits of DAAs among patients with HCV and ADRD.
OBJECTIVE
To examine use and survival benefits of DAAs in Medicare patients with HCV and ADRD.
METHODS
The study included Medicare patients with HCV between 2014 and 2017. We estimated Cox proportional hazards regressions to examine the association between having ADRD and DAA use, and the relation between DAA use and survival among patients with HCV and ADRD.
RESULTS
The adjusted hazard of initiating a DAA was 50% lower in patients with ADRD than those without ADRD (adjusted HR = 0.50, 95% CI: 0.46-0.54). The hazard of DAA use among ADRD patients with behavioral disturbances was 68% lower than non-ADRD patients (adjusted HR = 0.32, 95% CI: 0.28-0.37). DAA treatment was associated with a significant reduction in mortality among ADRD patients (adjusted HR = 0.52, 95% CI: 0.44-0.61).
CONCLUSION
The rate of DAA treatment in patients with HCV and ADRD was low, particularly among those with behavioral disturbance. The survival benefits of DAA treatment for patients with ADRD were substantial.
背景
由于老年人群中阿尔茨海默病和相关痴呆症（ADRD）和慢性丙型肝炎的高发，许多患有阿尔茨海默病和相关痴呆症（ADRD）的患者同时患有慢性丙型肝炎。直接作用抗病毒药物（DAAs）在治疗丙型肝炎病毒（HCV）方面非常有效。然而，ADRD 护理的复杂性可能会影响患有 HCV 和 ADRD 的患者对 DAA 的使用和结果。有关 HCV 和 ADRD 患者 DAA 的使用、与 DAA 使用相关的因素以及 DAA 的健康益处的信息很少。
目的
研究医疗保险患者中 HCV 和 ADRD 患者使用 DAA 的情况和生存获益。
方法
本研究纳入了 2014 年至 2017 年间患有 HCV 的医疗保险患者。我们估计了 Cox 比例风险回归，以检验 ADRD 与 DAA 使用之间的关联，以及 DAA 在 HCV 和 ADRD 患者中的使用与生存之间的关系。
结果
与无 ADRD 的患者相比，ADRD 患者开始使用 DAA 的调整后风险降低了 50%（调整后的 HR=0.50，95%CI：0.46-0.54）。有行为障碍的 ADRD 患者使用 DAA 的风险比非 ADRD 患者低 68%（调整后的 HR=0.32，95%CI：0.28-0.37）。DAA 治疗与 ADRD 患者死亡率的显著降低相关（调整后的 HR=0.52，95%CI：0.44-0.61）。
结论
HCV 和 ADRD 患者中 DAA 的治疗率较低，尤其是那些有行为障碍的患者。DAA 治疗对 ADRD 患者的生存获益显著。
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