Vital Signs: Hepatitis C Treatment Among Insured Adults - United States, 2019-2020.
Vital Signs: Hepatitis C Treatment Among Insured Adults - United States, 2019-2020.
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DOI：
10.15585/mmwr.mm7132e1
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发表时间：
2022-08-12
期刊：
影响因子：
--
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文献类型：
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在美国，超过200万成年人患有丙型肝炎病毒（HCV）感染，每年导致约14，000人死亡。建议丙型肝炎患者接受8至12周的高效直接作用抗病毒药物（DAA）治疗，可治愈≥ 95%的病例。来自HealthVerity（一个行政索赔和遭遇数据库）的数据用于构建一个年龄在18 - 69岁之间的成年人队列，这些成年人在2019年1月30日至2020年10月31日期间被诊断为HCV感染，在诊断前≥ 60天和诊断后≥ 360天连续入组保险（47，687）。采用多变量逻辑回归分析评估DAA治疗开始与性别、年龄、种族、支付者和医疗补助限制状态之间的关联;计算校正比值比（aOR）和95% CI。在医疗补助、医疗保险和私人保险接受者中，首次HCV RNA检测结果阳性后360天内开始DAA治疗的患病率分别为23%、28%和35%;在接受治疗的患者中，分别有75%、77%和84%在诊断后180天内开始治疗。接受医疗补助（aOR = 0.54; 95%CI = 0.51 - 0.57）和医疗保险（aOR = 0.62; 95%CI = 0.56 - 0.68）的患者开始治疗的调整几率低于接受私人保险的患者。在调整保险类型后，与50 - 59岁的人相比，18 - 29岁和30 - 39岁的医疗补助或私人保险成年人的治疗开始率最低。在医疗补助接受者中，在有医疗补助治疗限制的州，（aOR = 0.77; 95% CI = 0.74 - 0.81），而非限制性的州，以及种族编码为黑人或非裔美国人（黑人）的人（aOR = 0.93; 95% CI = 0.88 - 0.99）或其他种族（aOR = 0.73; 95% CI = 0.62 - 0.88）的受试者比种族编码为白色的受试者更易受感染。被诊断患有丙型肝炎的投保人很少能及时接受DAA治疗，而且治疗方面存在差异。不受限制地获得及时的DAA治疗对于减少病毒性肝炎相关死亡率、差异和传播至关重要。治疗可以挽救生命，防止传播，并节省费用。
Over 2 million adults in the United States have hepatitis C virus (HCV) infection, and it contributes to approximately 14,000 deaths a year. Eight to 12 weeks of highly effective direct-acting antiviral (DAA) treatment, which can cure ≥95% of cases, is recommended for persons with hepatitis C. Data from HealthVerity, an administrative claims and encounters database, were used to construct a cohort of adults aged 18–69 years with HCV infection diagnosed during January 30, 2019–October 31, 2020, who were continuously enrolled in insurance for ≥60 days before and ≥360 days after diagnosis (47,687). Multivariable logistic regression was used to assess the association between initiation of DAA treatment and sex, age, race, payor, and Medicaid restriction status; adjusted odds ratios (aORs) and 95% CIs were calculated. The prevalence of DAA treatment initiation within 360 days of the first positive HCV RNA test result among Medicaid, Medicare, and private insurance recipients was 23%, 28%, and 35%, respectively; among those treated, 75%, 77%, and 84%, respectively, initiated treatment within 180 days of diagnosis. Adjusted odds of treatment initiation were lower among those with Medicaid (aOR = 0.54; 95% CI = 0.51–0.57) and Medicare (aOR = 0.62; 95% CI = 0.56–0.68) than among those with private insurance. After adjusting for insurance type, treatment initiation was lowest among adults aged 18–29 and 30–39 years with Medicaid or private insurance, compared with those aged 50–59 years. Among Medicaid recipients, lower odds of treatment initiation were found among persons in states with Medicaid treatment restrictions (aOR = 0.77; 95% CI = 0.74–0.81) than among those in states without restrictions, and among persons whose race was coded as Black or African American (Black) (aOR = 0.93; 95% CI = 0.88–0.99) or other race (aOR = 0.73; 95% CI = 0.62–0.88) than those whose race was coded as White. Few insured persons with diagnosed hepatitis C receive timely DAA treatment, and disparities in treatment exist. Unrestricted access to timely DAA treatment is critical to reducing viral hepatitis–related mortality, disparities, and transmission. Treatment saves lives, prevents transmission, and is cost saving.
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DOI：
10.1016/s2468-1253(21)00397-6
发表时间：
2022-04
期刊：
The lancet. Gastroenterology & hepatology
影响因子：
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作者：
Solomon SS;Wagner-Cardoso S;Smeaton L;Sowah LA;Wimbish C;Robbins G;Brates I;Scello C;Son A;Avihingsanon A;Linas B;Anthony D;Nunes EP;Kliemann DA;Supparatpinyo K;Kityo C;Tebas P;Bennet JA;Santana-Bagur J;Benson CA;Van Schalkwyk M;Cheinquer N;Naggie S;Wyles D;Sulkowski M
通讯作者：
Sulkowski M
DOI：
10.1002/hep.30297
发表时间：
2019-03
期刊：
Hepatology (Baltimore, Md.)
影响因子：
--
作者：
Hofmeister MG;Rosenthal EM;Barker LK;Rosenberg ES;Barranco MA;Hall EW;Edlin BR;Mermin J;Ward JW;Ryerson AB
通讯作者：
Ryerson AB
影响因子：
39
作者：
Chahal, Harinder S.;Marseille, Elliot A.;Tice, Jeffrey A.;Pearson, Steve D.;Ollendorf, Daniel A.;Fox, Rena K.;Kahn, James G.
通讯作者：
Kahn, James G.
影响因子：
39.2
作者：
Falade-Nwulia O;Suarez-Cuervo C;Nelson DR;Fried MW;Segal JB;Sulkowski MS
通讯作者：
Sulkowski MS
影响因子：
5.9
作者：
Feldman EB;Balise R;Schiff E;Whitehead N;Thomas E
通讯作者：
Thomas E