Objective:

To assess disparities in hepatitis C treatment initiation among racial and sociodemographic groups at an urban academic medical center, focusing on treatment initiation rates.

Key Findings:

• Out of 4345 individuals, only 1150 (26.5%) were prescribed HCV treatment.
• Black individuals had lower treatment initiation rates compared to White individuals (aOR 0.68 [95% CI, .53–.88]).
• Individuals experiencing homelessness (aOR 0.57 [95% CI, .46–.69]) and those with Medicaid (aOR 0.82 [95% CI, .68–.98]) or no insurance (aOR 0.49 [95% CI, .37–.65]) were less likely to receive treatment.
• Individuals with mental health diagnoses were more likely to receive treatment (aOR 1.34 [95% CI, 1.11–1.61]).
• Untreated individuals had higher rates of inpatient (12.3%) and emergency department visits (17.7%) compared to treated individuals (3.4% and 4.8%, respectively).

Interpretation:

Significant disparities in HCV treatment initiation persist, particularly among Black individuals, those experiencing homelessness, and individuals with Medicaid or no insurance, contributing to a disproportionate burden of liver disease and preventable mortality in marginalized populations.

Limitations:

• The study is limited to a single urban academic medical center, which may not represent broader trends in HCV treatment disparities.
• Potential biases in electronic medical records may affect the accuracy of treatment initiation data.

Conclusion:

Despite the availability of effective treatments, systemic disparities in HCV treatment access remain, necessitating targeted interventions to improve equity in healthcare delivery.