While hepatitis C treatment rates have improved since the introduction of direct-acting antivirals, researchers found that overall treatment rates in a large, ethnically diverse cohort were less than 20% and lowest among Hispanic patients and those with Medicaid or indigent care, according to a recently published study.
“Among our multi-centered real-world community-based cohort of chronic HCV patients, overall access to HCV treatment remained low,” Robert J. Wong, MD, from Highland Hospital, California, and colleagues wrote. “More advocacy and action are needed to affect policy changes to ensure equitable access to HCV treatment for all those in need.”
To determine disparities in HCV treatment rates, Wong and colleagues analyzed 29,544 adults with chronic HCV admitted to one of four large urban hospitals systems in the U.S. between Jan. 1, 2011, and Feb. 28, 2017.
Of the patients included in the study, 17.8% received treatment and 82.2% did not. Demographically, 55.9% were white, 38.4% were black, 8.8% were Hispanic, 25.9% had Medicare, 22.5% had commercial insurance, 21.7% had indigent care, and 18.7% had Medicaid.
Regarding risky behavior, 36.6% had a history of current or past alcohol use, 25.6% had current or previous drug use, and 19.5% had a history of risky sexual behavior.
Compared with patients who did not received treatment, those who did were more likely to be aged 65 years or older (15.5% vs. 9.7%; P < .0001), have Medicare (39.8% vs. 22.8%; P < .0001) and more likely to have commercial insurance (39.7% vs. 18.8%; P < .0001). Patients who did not receive treatment were more likely to have HIV (P < .0001), psychiatric or behavioral disorders (P < .0001) and extrahepatic cancer (P < .0001).
After adjusting for sociodemographic, clinical and system factors, Wong and colleagues found that Hispanic patients were significantly less likely to receive treatment compared with white patients (OR = 0.48; 95% CI, 0.39-0.6), while Asian and Native American patients were more likely to receive treatment (OR = 1.43; 95% CI, 1.22-1.67).
Additionally, patients with Medicare (OR = 0.79; 95% CI, 0.71-0.88), Medicaid or State insurance (OR = 0.21; 95% CI, 0.2-0.24), and those with indigent care or no insurance (OR = 0.19; 95% CI, 0.15-0.21) were significantly less likely to receive treatment compared with those with commercial insurance.
“Even when our analysis was limited to the era after the availability of DAAs, these demographic and payer-specific disparities in access to HCV treatment persisted, indicating that the overall improvement in access to HCV treatment did not mitigate the disparities observed,” the researchers concluded. – by Talitha Bennett
Disclosure: Wong reports financial relationships with Gilead Sciences. Please see the full study for the other authors’ relevant financial disclosures.