Clinical Scorecard: Disparities in Hepatitis C Treatment Among Racial and Sociodemographic Groups at an Urban Academic Medical Center from 2018 to 2023
At a Glance
Category
Detail
Condition
Hepatitis C virus (HCV) infection
Key Mechanisms
Chronic HCV infection can lead to cirrhosis, liver failure, and hepatocellular carcinoma; direct-acting antivirals (DAAs) offer >95% cure rates with 8- to 12-week oral regimens
Target Population
Individuals with positive HCV RNA, including racial minorities, socially disadvantaged groups, and those experiencing homelessness
Care Setting
Urban academic medical center with inpatient and outpatient services
Key Highlights
Only 26.5% of 4345 individuals with positive HCV RNA were prescribed treatment between 2018 and 2023.
Black individuals, those experiencing homelessness, and patients with Medicaid or no insurance had significantly lower odds of receiving HCV treatment.
Individuals with mental health diagnoses were more likely to receive treatment; untreated patients had higher inpatient and emergency department utilization.
Guideline-Based Recommendations
Diagnosis
Confirm HCV infection with positive HCV RNA testing.
Management
Initiate direct-acting antiviral therapy promptly for all eligible patients to achieve cure.
Address social determinants and barriers to care, especially in marginalized populations.
Monitoring & Follow-up
Monitor treatment adherence and response to DAA therapy.
Track healthcare utilization to identify untreated patients at risk of complications.
Risks
Untreated HCV leads to cirrhosis in 20%–25% over 25–30 years and increased risk of hepatocellular carcinoma.
Disparities in treatment perpetuate higher morbidity and mortality in marginalized groups.
Patient & Prescribing Data
4345 individuals with positive HCV RNA at an urban academic medical center from 2018 to 2023
26.5% received DAA treatment; Black race, homelessness, Medicaid or no insurance decreased likelihood of treatment; mental health diagnoses increased likelihood.
Clinical Best Practices
Implement targeted interventions to reduce racial and sociodemographic disparities in HCV treatment initiation.
Leverage integrated healthcare systems to improve access and linkage to care for marginalized populations.
Incorporate mental health services to support treatment uptake and adherence.
Advocate for policy reforms beyond insurance coverage to address structural barriers.
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
