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Temporal Trends in Hepatitis C-Related Hospitalizations, United States, 2000-2019
Megan G Hofmeister1, Yuna Zhong1, Anne C Moorman1
1Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia.
Insights
Hepatitis C virus (HCV) hospitalizations decreased after 2013 with direct-acting antiviral (DAA) availability. However, declines varied by demographics, highlighting the need for equitable DAA access to eliminate HCV as a public health threat.
Area of Science:
- Hepatology
- Infectious Diseases
- Public Health
Background:
- Hepatitis C virus (HCV) infection presents a significant hospitalization burden.
- Understanding temporal trends in HCV hospitalizations is crucial, especially following the advent of direct-acting antiviral (DAA) therapies.
Purpose of the Study:
- To describe temporal trends in HCV-related hospitalization rates.
- To analyze these trends before and after the introduction of DAAs.
Main Methods:
- Utilized data from the National Inpatient Sample (2000-2019) for adults aged 18 years and older.
- Defined HCV-related hospitalizations based on primary or secondary diagnoses.
- Analyzed national characteristics and age-adjusted hospitalization rates.
Main Results:
- An estimated 1,286,397 HCV-related hospitalizations occurred between 2000-2019.
- Age-adjusted hospitalization rates peaked in 2012 and declined by 2019, with significant increases observed in specific age groups (55-64 years), Medicaid recipients, and Black non-Hispanic individuals.
- Hospitalizations were most common among individuals aged 45-64, males, White non-Hispanic persons, and those with Medicaid/Medicare.
Conclusions:
- HCV hospitalization rates declined post-2013, coinciding with DAA availability.
- Disparities in these declines were noted across age, race/ethnicity, and insurance categories.
- Expanded DAA treatment access, particularly for Medicaid/Medicare recipients, is essential to reduce disparities and work towards HCV elimination.
Background:
Hospitalization burden related to hepatitis C virus (HCV) infection is substantial. We sought to describe temporal trends in hospitalization rates before and after release of direct-acting antiviral (DAA) agents.
Methods:
We analyzed 2000-2019 data from adults aged ≥18 years in the National Inpatient Sample. Hospitalizations were HCV-related if (1) hepatitis C was the primary diagnosis, or (2) hepatitis C was any secondary diagnosis with a liver-related primary diagnosis. We analyzed characteristics of HCV-related hospitalizations nationally and examined trends in age-adjusted hospitalization rates.
Results:
During 2000-2019, there were an estimated 1 286 397 HCV-related hospitalizations in the United States. The annual age-adjusted hospitalization rate was lowest in 2019 (18.7/100 000 population) and highest in 2012 (29.6/100 000 population). Most hospitalizations occurred among persons aged 45-64 years (71.8%), males (67.1%), White non-Hispanic persons (60.5%), and Medicaid/Medicare recipients (64.0%). The national age-adjusted hospitalization rate increased during 2000-2003 (annual percentage change [APC], 9.4%; P < .001) and 2003-2013 (APC, 1.8%; P < .001) before decreasing during 2013-2019 (APC, -7.6%; P < .001). Comparing 2000 to 2019, the largest increases in hospitalization rates occurred among persons aged 55-64 years (132.9%), Medicaid recipients (41.6%), and Black non-Hispanic persons (22.3%).
Conclusions:
Although multiple factors likely contributed, overall HCV-related hospitalization rates declined steadily after 2013, coinciding with the release of DAAs. However, the declines were not observed equally among age, race/ethnicity, or insurance categories. Expanded access to DAA treatment is needed, particularly among Medicaid and Medicare recipients, to reduce disparities and morbidity and eliminate hepatitis C as a public health threat.
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