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A Protocol for Analyzing Hepatitis C Virus Replication
Published on: June 26, 2014
Rate and predictors of treatment prescription for hepatitis C
Adeel A Butt1, Amy C Justice, Melissa Skanderson
1University of Pittsburgh Medical Center, Falk Medical Building, Pittsburgh, PA 15213, USA. butta@dom.pitt.edu
Insights
Hepatitis C virus (HCV) treatment prescription rates in veterans are low, with only 11.8% receiving treatment. Older age, minority race, substance abuse, and comorbidities are linked to non-treatment, necessitating further investigation into these barriers.
Area of Science:
- Hepatology
- Infectious Diseases
- Health Services Research
Background:
- The actual treatment rate for hepatitis C virus (HCV) among veterans remains undetermined.
- Understanding treatment patterns is crucial for improving patient outcomes.
Purpose of the Study:
- To ascertain the rates of HCV treatment prescription.
- To identify factors predicting treatment prescription for HCV in a large national veteran population.
Main Methods:
- Utilized the Department of Veterans Affairs National Patient Care Database (NPCD) to identify HCV-infected veterans (1999-2003).
- Extracted demographic data, comorbidities (medical and psychiatric), and substance use diagnoses.
- Analyzed pharmacy data from the VA Pharmacy Benefits Management (PBM) database.
- Employed logistic regression to determine predictors of HCV treatment.
Main Results:
- Identified 113,927 veterans with HCV; the treatment prescription rate was 11.8%.
- Factors associated with non-treatment included older age, minority race, alcohol/drug abuse, and comorbid conditions (e.g., anemia, depression, schizophrenia).
- Factors associated with higher likelihood of treatment included liver cirrhosis and diabetes.
Conclusions:
- A low proportion of HCV-infected veterans received treatment.
- Non-treatment is associated with demographic factors (age, race) and significant comorbidities.
- Further research is needed to explore the reasons behind the low treatment rates and associated barriers.
Background:
The true treatment rate for hepatitis C virus (HCV) in veterans is unknown.
Aim:
To determine the treatment prescription rates and predictors of treatment prescription for HCV in a large national population.
Methods:
The Department of Veterans Affairs National Patient Care Database (NPCD) was used to identify all HCV-infected people between the fiscal years 1999 and 2003 using the International classification of diseases, 9th revision codes. Demographic information, medical and psychiatric comorbidities, and drug and alcohol use diagnoses were retrieved. Pharmacy data were retrieved from the Department of Veterans Affairs Pharmacy Benefits Management (PBM) database. Logistic regression analysis was used to determine the predictors of treatment for HCV in HCV.
Results:
113 927 veterans in the Department of Veterans Affairs care with a diagnosis of HCV were identified. The treatment prescription rate for HCV was 11.8%. Patients not prescribed treatment were older, more likely to be from minority races, have more alcohol and drug misuse, and have medical and psychiatric comorbid conditions. In a multivariate logistic regression model, the following factors were predictive of non-treatment for HCV: increasing age (odds ratio (OR) 0.77 for each 5-year increase in age; 95% confidence interval (CI) 0.76 to 0.78); black race (OR 0.64; 95% CI 0.6 to 0.68); Hispanic race (OR 0.88; 95% CI 0.8 to 0.96); alcohol abuse and dependence (OR 0.62; 95% CI 0.59 to 0.65); drug abuse and dependence (OR 0.78; 95% CI 0.74 to 0.82); anaemia (OR 0.18; 95% CI 0.16 to 0.21); hepatitis B infection (OR 0.72; 95% CI 0.62 to 0.83); coronary artery disease (OR 0.9; 95% CI 0.85 to 0.97); stroke (OR 0.75; 95% CI 0.67 to 0.85); bipolar disorder (OR 0.64; 95% CI 0.58 to 0.70); major depression (OR 0.72; 95% CI 0.67 to 0.77); mild depression (OR 0.56; 95% CI 0.53 to 0.59); and schizophrenia (OR 0.71; 95% CI 0.65 to 0.77). The following factors were associated with a higher likelihood of treatment prescription for HCV: liver cirrhosis (OR 1.6; 95% CI 1.5 to 1.7); and diabetes (OR 1.07; 95% CI 1.02 to 1.12).
Conclusions:
A small number of HCV-infected veterans were prescribed treatment for HCV. Non-treatment is associated with increasing age, non-white race, drug and alcohol abuse, and dependence and comorbid illnesses. Reasons for non-treatment need further study.
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