Hepatitis C Treatment Initiation Among US Medicaid Enrollees.
Hepatitis C Treatment Initiation Among US Medicaid Enrollees.
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DOI：
10.1001/jamanetworkopen.2023.27326
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发表时间：
2023-08-01
影响因子：
13.8
通讯作者：
Shapiro, Martin F.
中科院分区：
文献类型：
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作者：
Kapadia, Shashi N.;Zhang, Hao;Gonzalez, Christopher J.;Sen, Bisakha;Franco, Ricardo;Hutchings, Kayla;Wethington, Elaine;Talal, Andrew;Lloyd, Audrey;Dharia, Arpan;Wells, Martin;Bao, Yuhua;Shapiro, Martin F.
这项队列研究检查了在新诊断为丙型肝炎病毒后6个月内接受直接作用的抗病毒治疗的变化。在医疗补助登记者中开始丙型肝炎治疗是否存在差异？在这项对87652名美国医疗补助计划参与者进行的回顾性队列研究中，丙型肝炎的总体治疗摄取率较低，30岁以下人群、女性、西班牙裔和亚洲人以及注射吸毒者的治疗起始率显著较低。这些研究结果表明，需要采取干预措施来提高丙型肝炎的整体治疗率和重点人群的治疗率，并确保医疗补助计划中的治疗公平性。丙型肝炎病毒（HCV）感染的直接作用抗病毒（DAA）治疗非常有效，但仍未得到充分利用。了解DAA提供的差异对于HCV消除规划和设计干预措施以促进公平治疗非常重要。检查新的HCV诊断后6个月内接受DAA的变化。这项回顾性队列研究使用了2017年至2019年来自50个州、华盛顿特区和波多黎各的国家医疗补助申请。包括2018年新诊断为HCV的18至64岁的个体。新的诊断定义为在1年回顾期后，要求进行HCV RNA检测，然后进行疾病和相关健康问题国际统计分类第十版（ICD-10）诊断代码。结果是在诊断后6个月内收到DAA处方。使用逻辑回归分析人口统计学因素和ICD-10确定的与治疗开始相关的合并症。在87652名个体中，43078名（49%）为女性，12355名（14%）年龄在18至29岁之间，35181名（40%）年龄在30至49岁之间，51282名（46%）为非西班牙裔白色人，48840名（49%）有注射吸毒诊断。在这些人中，17927人（20%）在首次诊断HCV后6个月内接受了DAA。在回归分析中，男性与治疗开始时间增加相关（OR，1.24; 95% CI，1.16-1.33）。年龄18 - 29岁（OR，0.65; 95% CI，0.50-0.85）和注射药物使用（OR，0.84; 95% CI，0.75-0.94）与治疗开始时间减少相关。调整状态固定效应后，亚裔（OR，0.50; 95% CI，0.40-0.64）、美洲印第安人或阿拉斯加原住民（OR，0.68; 95% CI，0.55-0.84）和西班牙裔（OR，0.81; 95% CI，0.71-0.93）与治疗开始时间减少相关。州医疗补助政策的调整并没有减少种族或民族差异。在这项回顾性队列研究中，HCV治疗的启动率在医疗补助受益人中较低，并因人口统计学特征和合并症而异。需要采取干预措施，以增加医疗补助受益人对HCV治疗的接受率，并解决关键人群（包括年轻人，女性，少数民族和种族群体的个人以及注射毒品的人）之间的治疗差异。
This cohort study examines variations in the receipt of direct-acting antiviral treatment in the 6 months following a new diagnosis for hepatitis C virus. Are there disparities in the initiation of hepatitis C treatment among Medicaid enrollees? In this retrospective cohort study of 87 652 US Medicaid enrollees, there was low treatment uptake for hepatitis C overall and significantly lower treatment initiation among people younger than 30 years, females, Hispanic and Asian individuals, and people with injection drug use. These findings suggest that interventions are needed to increase treatment rates for hepatitis C overall and among key populations and ensure equity in treatment within the Medicaid program. Direct-acting antiviral (DAA) treatment for hepatitis C virus (HCV) infection is highly effective but remains underused. Understanding disparities in the delivery of DAAs is important for HCV elimination planning and designing interventions to promote equitable treatment. To examine variations in the receipt of DAA in the 6 months following a new HCV diagnosis. This retrospective cohort study used national Medicaid claims from 2017 to 2019 from 50 states, Washington DC, and Puerto Rico. Individuals aged 18 to 64 years with a new diagnosis of HCV in 2018 were included. A new diagnosis was defined as a claim for an HCV RNA test followed by an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis code, after a 1-year lookback period. Outcome was receipt of a DAA prescription within 6 months of diagnosis. Logistic regression was used to examine demographic factors and ICD-10–identified comorbidities associated with treatment initiation. Among 87 652 individuals, 43 078 (49%) were females, 12 355 (14%) were age 18 to 29 years, 35 181 (40%) age 30 to 49, 51 282 (46%) were non-Hispanic White, and 48 840 (49%) had an injection drug use diagnosis. Of these individuals, 17 927 (20%) received DAAs within 6 months of their first HCV diagnosis. In the regression analyses, male sex was associated with increased treatment initiation (OR, 1.24; 95% CI, 1.16-1.33). Being age 18 to 29 years (OR, 0.65; 95% CI, 0.50-0.85) and injection drug use (OR, 0.84; 95% CI, 0.75-0.94) were associated with decreased treatment initiation. After adjustment for state fixed effects, Asian race (OR, 0.50; 95% CI, 0.40-0.64), American Indian or Alaska Native race (OR, 0.68; 95% CI, 0.55-0.84), and Hispanic ethnicity (OR, 0.81; 95% CI, 0.71-0.93) were associated with decreased treatment initiation. Adjustment for state Medicaid policy did not attenuate the racial or ethnic disparities. In this retrospective cohort study, HCV treatment initiation was low among Medicaid beneficiaries and varied by demographic characteristics and comorbidities. Interventions are needed to increase HCV treatment uptake among Medicaid beneficiaries and to address disparities in treatment among key populations, including younger individuals, females, individuals from minoritized racial and ethnic groups, and people who inject drugs.
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影响因子：
5.5
作者：
Harris, Aaron M.;Khan, Mohammed A.;Thompson, William W.
通讯作者：
Thompson, William W.
影响因子：
4.5
作者：
Barnett, Paul G.;Joyce, Vilija R.;Owens, Douglas K.
通讯作者：
Owens, Douglas K.
影响因子：
4.4
作者：
Janjua, Naveed Zafar;Islam, Nazrul;Krajden, Mel
通讯作者：
Krajden, Mel
DOI：
10.15585/mmwr.mm7132e1
发表时间：
2022-08-12
期刊：
MMWR. Morbidity and mortality weekly report
影响因子：
--
作者：
通讯作者：
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影响因子：
1.9
作者：
Lin, Oliver N.;Chang, Christine;Nguyen, Mindie H.
通讯作者：
Nguyen, Mindie H.