Lee Dong Heun, Chou Edgar Y, Moore Kari, Melly Steven, Zhao Yuzhe, Chen Hal, Buehler James W
Drexel University College of Medicine and Drexel University Physicians Practice Plan, Philadelphia, PA, United States.
Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States.
Prev Med Rep. 2022 Oct 3;30:102011. doi: 10.1016/j.pmedr.2022.102011. eCollection 2022 Dec.
Among patients of an urban primary care network in Philadelphia with a universal hepatitis C virus (HCV) screening policy for patients born during 1945-1965, we examined whether being unscreened and HCV positivity were associated with attributes of the census tracts where patients resided, which we considered as proxies for social health determinants. For patients with at least one clinic visit between 2014 and mid-2017, we linked demographic and HCV screening information from electronic health records with metrics that described the census tracts where patients resided. We used generalized estimating equations to estimate adjusted relative risk ratios (aRRs) for being unscreened and HCV positive. Overall, 28% of 6,906 patients were unscreened. Black race, male gender, and residence in census tracts with relatively high levels of violent crime, low levels of educational attainment and household incomes, and evidence of residential segregation by Hispanic ethnicity were associated with lower aRRs for being unscreened. Among screened patients, 9% were HCV positive. Factors associated with lower risks of being unscreened were, in general, associated with higher HCV positivity. Attributes of census tracts where patients reside are probably less apparent to clinicians than patients' gender or race but might reflect unmeasured patient characteristics that affected screening practices, along with preconceptions regarding the likelihood of HCV infection based on prior screening observations or implicit biases. Approaching complete detection of HCV-infected people would be hastened by focusing on residents of census tracts with attributes associated with higher infection levels or, if known, higher infection levels directly.
在费城一个实行针对1945年至1965年出生患者的丙型肝炎病毒（HCV）普遍筛查政策的城市初级保健网络的患者中，我们研究了未接受筛查以及HCV阳性是否与患者居住的普查区属性相关，我们将这些属性视为社会健康决定因素的代理指标。对于在2014年至2017年年中期间至少有一次门诊就诊的患者，我们将电子健康记录中的人口统计学和HCV筛查信息与描述患者居住普查区的指标相链接。我们使用广义估计方程来估计未接受筛查和HCV阳性的调整后相对风险比（aRRs）。总体而言，6906名患者中有28%未接受筛查。黑人种族、男性、居住在暴力犯罪率相对较高、教育程度和家庭收入水平较低以及有西班牙裔种族居住隔离证据的普查区与未接受筛查的较低aRRs相关。在接受筛查的患者中，9%为HCV阳性。与未接受筛查风险较低相关的因素，总体上与较高的HCV阳性相关。患者居住普查区的属性对临床医生来说可能不如患者的性别或种族明显，但可能反映了影响筛查行为的未测量患者特征，以及基于先前筛查观察或隐性偏见对HCV感染可能性的先入之见。通过关注具有与较高感染水平相关属性的普查区居民，或者如果已知的话，直接关注感染水平较高的居民，将加速接近对HCV感染者的完全检测。
