Disparities in Hepatitis C Treatment Among Racial and Sociodemographic Groups
Overview
This retrospective cohort study at an urban academic medical center from 2018 to 2023 identified significant disparities in hepatitis C virus (HCV) treatment initiation. Black individuals, those experiencing homelessness, and patients with Medicaid or no insurance were less likely to receive direct-acting antiviral (DAA) therapy despite the availability of effective treatments.
Background
Hepatitis C virus infection remains a major public health issue in the United States, with serious long-term complications such as cirrhosis and hepatocellular carcinoma if untreated. The introduction of direct-acting antiviral therapies has revolutionized treatment, offering cure rates exceeding 95%. However, treatment uptake remains suboptimal, particularly among racial minorities and socially disadvantaged populations. National efforts aim to eliminate HCV, but disparities persist even in well-resourced healthcare settings.
Data Highlights
Characteristic
Adjusted Odds Ratio (aOR)
95% Confidence Interval
Black vs White individuals
0.68
0.53–0.88
Experiencing homelessness
0.57
0.46–0.69
Medicaid insurance
0.82
0.68–0.98
No insurance
0.49
0.37–0.65
Mental health diagnosis
1.34
1.11–1.61
Inpatient visits (untreated vs treated)
12.3% vs 3.4%
Emergency department visits (untreated vs treated)
17.7% vs 4.8%
Key Findings
Only 26.5% of 4345 individuals with positive HCV RNA were prescribed DAA treatment.
Black individuals had 32% lower odds of receiving HCV treatment compared to White individuals.
Individuals experiencing homelessness had 43% lower odds of treatment initiation.
Patients with Medicaid or no insurance were significantly less likely to receive treatment compared to those with private insurance.
Individuals with mental health diagnoses were more likely to receive HCV treatment.
Untreated individuals had higher rates of inpatient and emergency department visits, indicating greater healthcare utilization and possibly worse health outcomes.
Clinical Implications
Clinicians should be aware of persistent treatment disparities in HCV care, particularly among Black patients, those experiencing homelessness, and uninsured or Medicaid-insured individuals. Addressing social determinants of health and improving access to treatment in these populations is critical to reducing morbidity and mortality. Mental health engagement may facilitate treatment initiation and should be leveraged in care models.
Conclusion
Despite effective and accessible HCV therapies, significant disparities in treatment initiation persist in a well-resourced urban academic medical center. Multifaceted interventions beyond policy reform are needed to achieve equitable HCV elimination.
References
Mass General Brigham Study 2018-2023 -- Disparities in Hepatitis C Treatment Among Racial and Sociodemographic Groups
by Ahmed D Elnaiem, Anand B Chukka, Cynthia M So-Armah, MaryCatherine E Arbour, Chuan-Chin Huang, Daniel A Solomon, Lauren E Malishchak, Chase G Yarbrough
