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Am J Gastroenterol. 2018 Sep;113(9):1329-1338. doi: 10.1038/s41395-018-0033-8. Epub 2018 Mar 9.

Race/ethnicity and insurance status disparities in access to direct acting antivirals for hepatitis C virus treatment.

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Division of Gastroenterology and & Hepatology, Alameda Health System-Highland Hospital, Oakland, CA, USA.
Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Parkland Health and Hospital System, Dallas, TX, USA.
Multi-Organ Transplant Institute, Ochsner Health System, New Orleans, LA, USA.
Liver Institute of Virginia, Bon Secours Health System, Richmond, VA, USA.
Medical Technology and Practice Patterns Institute, Bethesda, MD, USA.



Despite availability of highly effective direct acting antivirals (DAA), barriers in access to these therapies limit our ability to achieve HCV eradication. We aim to evaluate overall rates and predictors of HCV treatment across four community-based health-care systems focusing on race/ethnicity and insurance-specific disparities.


We retrospectively evaluated all adults with chronic HCV at four health care systems from 1 January 2011 to 28 February 2017, which included a large proportion of ethnic minorities, two safety-net systems, and a broad payer mix across four states. Overall and stratified HCV treatment rates were calculated using Kaplan-Meier methods. Multivariate logistic regression models evaluated for predictors of receiving treatment.


Among 29,544 chronic HCV patients (60.5% male, 38.4% black, 8.8% Hispanic, 18.7% Medicaid, 25.9% Medicare, 22.5% private/commercial), overall annual treatment rates were stable from 2011 (0.5%) to 2013 (2.0%), but increased from 2014 (4.8%) to 2017 (16.9%) after availability of DAAs. While similar treatment rates were observed by sex, significantly lower odds of treatment were observed in Hispanics (OR 0.48, 95% CI 0.39-0.60, pā€‰<ā€‰0.001) compared to non-Hispanic whites and among those with Medicaid (OR 0.21, 95% CI 0.20-0.24, pā€‰<ā€‰0.001) compared to commercially insured patients.


Among our cohort of 29,544 chronic HCV patients, we observed significant improvements in HCV treatment rates after the availability of DAAs in 2014, but overall treatment rates remained <20% in 2017. The lowest rates of treatment were seen among Hispanics and those with Medicaid or indigent care insurance, which is concerning given these are particularly vulnerable populations.


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