2014 - 2017年美国医疗保险患者中丙型肝炎直接抗病毒药物使用方面城乡差距的变化
Changing Urban-Rural Disparities in the Utilization of Direct-Acting Antiviral Agents for Hepatitis C in U.S. Medicare Patients, 2014-2017.
作者信息
Du Ping, Wang Xi, Kong Lan, Riley Thomas, Jung Jeah
机构信息
Department of Medicine, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania; Department of Public Health Sciences, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania.
Department of Public Health Sciences, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania.
出版信息
Am J Prev Med. 2021 Feb;60(2):285-293. doi: 10.1016/j.amepre.2020.08.031. Epub 2020 Nov 19.
INTRODUCTION
The advent of direct-acting antiviral agents for treating hepatitis C virus infection has made hepatitis C virus elimination possible. Rural patients with hepatitis C virus infection may be less likely to access direct-acting antiviral agents, but the real-world evidence is scarce on urban-rural disparities in direct-acting antiviral agent utilization.
METHODS
This retrospective cohort study was conducted in 2019-2020 using Medicare data to examine urban-rural disparities in direct-acting antiviral agent utilization among newly diagnosed patients with hepatitis C virus infection in 2014-2016. Direct-acting antiviral agent use was defined as filling ≥1 prescription for direct-acting antiviral agents during 2014-2017, and patient's urban-rural status was classified on the basis of their ZIP code of residence. This study evaluated the associations between multilevel factors and direct-acting antiviral agent use with a focus on urban-rural disparities. It also assessed changes over time in urban-rural disparities in direct-acting antiviral agent utilization using multivariable cause-specific Cox regression analyses with time-varying hazard ratios.
RESULTS
Among 204,018 new patients with hepatitis C virus infection, about 30% received direct-acting antiviral agents during 2014-2017. Cumulative direct-acting antiviral agent use gradually increased over time in both urban and rural patients. However, the increase was greater in urban patients than in rural patients. In the first year of follow-up, rural patients had a similar rate of receiving direct-acting antiviral agents (adjusted hazard ratio=1.03, 95% CI=1.00, 1.07), but they were less likely to use direct-acting antiviral agents in later years than urban patients (adjusted hazard ratio=0.85, 95% CI=0.81, 0.90 in the second year, adjusted hazard ratio=0.82, 95% CI=0.76, 0.89 in the third year, and adjusted hazard ratio=0.76, 95% CI=0.64, 0.90 in the fourth year of follow-up).
CONCLUSIONS
This study reveals important gaps in hepatitis C virus treatment and suggests increasing urban-rural disparities in direct-acting antiviral agent utilization. Enhancing direct-acting antiviral agent uptake in rural populations with hepatitis C virus infection will help reduce hepatitis C virus‒related health disparities and reach the national goal of eliminating hepatitis C virus infection.
引言
用于治疗丙型肝炎病毒感染的直接抗病毒药物的出现使消除丙型肝炎病毒成为可能。丙型肝炎病毒感染的农村患者获得直接抗病毒药物的可能性可能较低，但关于直接抗病毒药物使用方面城乡差异的真实世界证据却很匮乏。
方法
这项回顾性队列研究于2019 - 2020年进行，利用医疗保险数据来研究2014 - 2016年新诊断的丙型肝炎病毒感染患者在直接抗病毒药物使用方面的城乡差异。直接抗病毒药物的使用定义为在2014 - 2017年期间开具≥1张直接抗病毒药物处方，患者的城乡状况根据其居住邮政编码进行分类。本研究评估了多层次因素与直接抗病毒药物使用之间的关联，重点关注城乡差异。它还使用具有随时间变化风险比的多变量特定病因Cox回归分析评估了直接抗病毒药物使用方面城乡差异随时间的变化。
结果
在204,018名新的丙型肝炎病毒感染患者中，约30%在2014 - 2017年期间接受了直接抗病毒药物治疗。城乡患者的直接抗病毒药物累计使用量均随时间逐渐增加。然而，城市患者的增加幅度大于农村患者。在随访的第一年，农村患者接受直接抗病毒药物的比例相似（调整后风险比 = 1.03，95%置信区间 = 1.00, 1.07），但在随后几年中，他们使用直接抗病毒药物的可能性低于城市患者（第二年调整后风险比 = 0.85，95%置信区间 = 0.81, 0.90；第三年调整后风险比 = 0.82，95%置信区间 = 0.76, 0.89；随访第四年调整后风险比 = 0.76，95%置信区间 = 0.64, 0.90）。
结论
本研究揭示了丙型肝炎病毒治疗方面的重要差距，并表明直接抗病毒药物使用方面的城乡差异在增加。提高丙型肝炎病毒感染农村人群对直接抗病毒药物的接受度将有助于减少与丙型肝炎病毒相关的健康差距，并实现消除丙型肝炎病毒感染的国家目标。
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