Division of Infectious Diseases, Weill Cornell Medicine, New York, New York.
Department of Population Health Sciences, Weill Cornell Medicine, New York, New York.
JAMA Netw Open. 2023 Aug 1;6(8):e2327326. doi: 10.1001/jamanetworkopen.2023.27326.
Direct-acting antiviral (DAA) treatment for hepatitis C virus (HCV) infection is highly effective but remains underused. Understanding disparities in the delivery of DAAs is important for HCV elimination planning and designing interventions to promote equitable treatment.
To examine variations in the receipt of DAA in the 6 months following a new HCV diagnosis.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used national Medicaid claims from 2017 to 2019 from 50 states, Washington DC, and Puerto Rico. Individuals aged 18 to 64 years with a new diagnosis of HCV in 2018 were included. A new diagnosis was defined as a claim for an HCV RNA test followed by an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis code, after a 1-year lookback period.
Outcome was receipt of a DAA prescription within 6 months of diagnosis. Logistic regression was used to examine demographic factors and ICD-10-identified comorbidities associated with treatment initiation.
Among 87 652 individuals, 43 078 (49%) were females, 12 355 (14%) were age 18 to 29 years, 35 181 (40%) age 30 to 49, 51 282 (46%) were non-Hispanic White, and 48 840 (49%) had an injection drug use diagnosis. Of these individuals, 17 927 (20%) received DAAs within 6 months of their first HCV diagnosis. In the regression analyses, male sex was associated with increased treatment initiation (OR, 1.24; 95% CI, 1.16-1.33). Being age 18 to 29 years (OR, 0.65; 95% CI, 0.50-0.85) and injection drug use (OR, 0.84; 95% CI, 0.75-0.94) were associated with decreased treatment initiation. After adjustment for state fixed effects, Asian race (OR, 0.50; 95% CI, 0.40-0.64), American Indian or Alaska Native race (OR, 0.68; 95% CI, 0.55-0.84), and Hispanic ethnicity (OR, 0.81; 95% CI, 0.71-0.93) were associated with decreased treatment initiation. Adjustment for state Medicaid policy did not attenuate the racial or ethnic disparities.
In this retrospective cohort study, HCV treatment initiation was low among Medicaid beneficiaries and varied by demographic characteristics and comorbidities. Interventions are needed to increase HCV treatment uptake among Medicaid beneficiaries and to address disparities in treatment among key populations, including younger individuals, females, individuals from minoritized racial and ethnic groups, and people who inject drugs.
直接作用抗病毒 (DAA) 治疗丙型肝炎病毒 (HCV) 感染非常有效，但仍未得到充分利用。了解 DAA 提供方面的差异对于 HCV 消除规划和设计促进公平治疗的干预措施非常重要。
研究在 HCV 新诊断后 6 个月内接受 DAA 的情况变化。
设计、设置和参与者：本回顾性队列研究使用了 2017 年至 2019 年来自 50 个州、华盛顿特区和波多黎各的全国性医疗补助索赔数据。纳入了 2018 年 HCV 新诊断的 18 至 64 岁人群。新诊断的定义是在 1 年的回溯期后，HCV RNA 检测的索赔后出现国际疾病分类第十次修订版 (ICD-10) 诊断代码。
结果是在诊断后 6 个月内接受 DAA 处方。使用逻辑回归检查与治疗开始相关的人口统计学因素和 ICD-10 确定的合并症。
在 87652 名患者中，43078 名（49%）为女性，12355 名（14%）年龄为 18 至 29 岁，35181 名（40%）年龄为 30 至 49 岁，51282 名（46%）为非西班牙裔白人，48840 名（49%）有注射吸毒诊断。在这些人中，17927 名（20%）在 HCV 首次诊断后的 6 个月内接受了 DAA。在回归分析中，男性（OR，1.24；95%CI，1.16-1.33）与治疗开始增加相关。年龄在 18 至 29 岁（OR，0.65；95%CI，0.50-0.85）和注射吸毒（OR，0.84；95%CI，0.75-0.94）与治疗开始减少相关。在调整州固定效应后，亚洲种族（OR，0.50；95%CI，0.40-0.64）、美洲印第安人或阿拉斯加原住民种族（OR，0.68；95%CI，0.55-0.84）和西班牙裔（OR，0.81；95%CI，0.71-0.93）与治疗开始减少相关。调整州医疗补助政策并没有减轻种族或族裔差异。
在这项回顾性队列研究中，医疗补助受益人的 HCV 治疗开始率较低，且因人口统计学特征和合并症而异。需要采取干预措施，以提高医疗补助受益人的 HCV 治疗率，并解决关键人群（包括年轻人、女性、少数族裔和族裔群体以及注射吸毒者）在治疗方面的差异。
