Division of Viral HepatitisCenters for Disease Control and PreventionAtlantaGAUSA.
Henry Ford Health SystemDetroitMIUSA.
Hepatol Commun. 2020 Nov 29;5(3):400-411. doi: 10.1002/hep4.1632. eCollection 2021 Mar.
There are limited data examining the relationship between psychosocial factors and receipt of direct-acting antiviral (DAA) treatment among patients with hepatitis C in large health care organizations in the United States. We therefore sought to determine whether such factors were associated with DAA initiation. We analyzed data from an extensive psychological, behavioral, and social survey (that incorporated several health-related quality of life assessments) coupled with clinical data from electronic health records of patients with hepatitis C enrolled at four health care organizations during 2017-2018. Of 2,681 patients invited, 1,051 (39.2%) responded to the survey; of 894 respondents eligible for analysis, 690 (77.2%) initiated DAAs. Mean follow-up among respondents was 9.2 years. Compared with DAA recipients, nonrecipients had significantly poorer standardized scores for depression, anxiety, and life-related stressors as well as poorer scores related to physical and mental function. Lower odds of DAA initiation in multivariable analysis (adjusted by age, race, sex, study site, payment provider, cirrhosis status, comorbidity status, and duration of follow-up) included Black race (adjusted odds ratio [aOR], 0.59 vs. White race), perceived difficulty getting medical care in the preceding year (aOR, 0.48 vs. no difficulty), recent injection drug use (aOR, 0.11 vs. none), alcohol use disorder (aOR, 0.58 vs. no alcohol use disorder), severe depression (aOR, 0.42 vs. no depression), recent homelessness (aOR, 0.36 vs. no homelessness), and recent incarceration (aOR, 0.34 vs. no incarceration). In addition to racial differences, compared with respondents who initiated DAAs, those who did not were more likely to have several psychological, behavioral, and social impairments. Psychosocial barriers to DAA initiation among patients in care should also be addressed to reduce hepatitis C-related morbidity and mortality.
在美国的大型医疗机构中，有关心理社会因素与丙型肝炎患者直接作用抗病毒（DAA）治疗之间关系的研究数据有限。因此，我们试图确定这些因素是否与 DAA 的起始有关。我们分析了来自广泛的心理、行为和社会调查的数据（该调查纳入了几项与健康相关的生活质量评估），并结合了 2017 年至 2018 年期间在四个医疗机构接受丙型肝炎治疗的患者的电子健康记录中的临床数据。在邀请的 2681 名患者中，有 1051 名（39.2%）对调查做出了回应；在 894 名符合分析条件的应答者中，有 690 名（77.2%）开始接受 DAA 治疗。应答者的平均随访时间为 9.2 年。与 DAA 接受者相比，未接受者的抑郁、焦虑和与生活相关的压力源的标准化评分明显较差，以及与身体和精神功能相关的评分也较差。多变量分析中 DAA 起始率较低（通过年龄、种族、性别、研究地点、支付方、肝硬化状态、合并症状态和随访时间进行调整）包括黑人种族（调整后的优势比 [aOR]，0.59 与白人种族）、前一年感觉获得医疗保健有困难（aOR，0.48 与无困难）、最近使用注射毒品（aOR，0.11 与无使用）、酒精使用障碍（aOR，0.58 与无酒精使用障碍）、严重抑郁（aOR，0.42 与无抑郁）、最近无家可归（aOR，0.36 与无无家可归）和最近监禁（aOR，0.34 与无监禁）。除了种族差异外，与开始接受 DAA 的应答者相比，未开始接受 DAA 的应答者更有可能存在几种心理、行为和社会障碍。在接受治疗的患者中，DAA 起始的心理社会障碍也应得到解决，以降低丙型肝炎相关发病率和死亡率。
