Regional and Rural-Urban Differences in the Use of Direct-acting Antiviral Agents for Hepatitis C Virus The Veteran Birth Cohort
Regional and Rural-Urban Differences in the Use of Direct-acting Antiviral Agents for Hepatitis C Virus The Veteran Birth Cohort
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DOI：
10.1097/mlr.0000000000001071
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发表时间：
2019-04-01
期刊：
影响因子：
3
通讯作者：
Justice, Amy C.
中科院分区：
文献类型：
--
作者：
Njei, Basile;Esserman, Denise;Justice, Amy C.
背景资料：感染丙型肝炎病毒（HCV）的退伍军人可能面临获得治疗的地理障碍。目的：我们研究了地区和农村与城市居住地对接受直接作用的抗逆转录病毒（DAA）药物治疗HCV的影响。受试者：1945年至1965年出生的退伍军人事务部医疗保健系统内接受治疗的退伍军人。这是一项使用国家电子健康记录数据的观察性研究。测量：DAA的接收定义为2014年1月1日至2016年12月31日期间>= 1个已填写的处方。区域（南部，东北部，中西部，和西部）和居住（城市，农村-小都市，农村小城镇和孤立的农村城镇）变量创建使用住宅区改善计划代码和城乡通勤区（RUCA）代码。多变量模型根据年龄、种族、性别、肝病严重程度、合并症和既往治疗经验进行调整。结果：在166，353例符合条件的患者中，64，854例接受了DAA。城乡住宅的差异取决于地区。在未经调整的分析中，接收不同的农村-城市指定在中西部和西部地区（P
Background: Veterans with hepatitis C virus (HCV) infection may face geographic obstacles to obtaining treatment.Objective: We studied the influence of region and rural versus urban residence on receipt of direct-acting antiretroviral (DAA) medications for HCV.Subjects: Veterans receiving care within Veterans Affairs Healthcare System born between 1945 and 1965.Research Design: This is a observational study using national electronic health record data.Measures: Receipt of DAAs was defined as >= 1 filled prescription from January 1, 2014 to December 31, 2016. Region (South, Northeast, Midwest, andWest) and residence (urban, rural-micropolitan, small rural towns, and isolated rural towns) variables were created using residential zone improvement plan codes and rural-urban commuting area (RUCA) codes. Multivariable models were adjusted for age, race, sex, severity of liver disease, comorbidities, and prior treatment experience.Results: Among 166,353 eligible patients 64,854 received, DAAs. Variation by rural-urban residence depended on region. In unadjusted analyses, receipt varied by rural-urban designations within Midwest, and West regions (P