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Racial and Sociodemographic Disparities in Hepatitis C Treatment at an Urban Academic Medical Center, 2018-2023

Ahmed D Elnaiem1,2, Anand B Chukka1, Cynthia M So-Armah3,4

  • 1Faculty of Medicine, Harvard Medical School, Boston, Massachusetts, USA.

Open Forum Infectious Diseases
|June 16, 2025
PubMed

Insights

Hepatitis C virus (HCV) treatment initiation is lower in Black individuals, those experiencing homelessness, and uninsured patients, despite effective therapies. These disparities exacerbate liver disease burdens in marginalized communities.

Area of Science:

  • Hepatology and Infectious Diseases
  • Health Services Research
  • Health Equity

Background:

  • Hepatitis C virus (HCV) disproportionately impacts racial minorities and socially disadvantaged populations in the U.S.
  • Direct-acting antiviral (DAA) therapies offer highly effective HCV treatment, yet significant disparities in treatment initiation persist.
  • Understanding predictors of treatment initiation is crucial for addressing these inequities.

Purpose of the Study:

  • To identify sociodemographic and clinical predictors of HCV treatment initiation among a diverse patient cohort.
  • To quantify disparities in direct-acting antiviral (DAA) prescription rates based on race, insurance status, and housing stability.
  • To inform targeted interventions aimed at reducing HCV treatment inequities.

Main Methods:

  • Retrospective cohort study utilizing electronic medical record data from an urban academic medical center (October 2018–October 2023).
  • Inclusion criteria: individuals with positive HCV RNA.
  • Multivariable logistic regression analysis to determine predictors of HCV treatment initiation (defined as DAA prescription).

Main Results:

  • Among 4345 individuals, 1150 (26.5%) received HCV treatment.
  • Black individuals had lower odds of treatment initiation compared to White individuals (aOR, 0.68).
  • Lower treatment initiation odds were observed for individuals experiencing homelessness (aOR, 0.57), with Medicaid (aOR, 0.82), or uninsured (aOR, 0.49).
  • Individuals with mental health diagnoses had higher odds of treatment initiation (aOR, 1.34).
  • Untreated individuals showed higher rates of inpatient and emergency department visits.

Conclusions:

  • Significant disparities in HCV treatment initiation exist, particularly affecting Black individuals, those experiencing homelessness, and those with public or no insurance.
  • These inequities contribute to a greater burden of liver disease and preventable mortality in marginalized groups.
  • Addressing social determinants of health is essential to achieving equitable HCV treatment outcomes.
Abstract

Keywords:
direct-acting antiviralshealthcare disparitieshepatitis Ctreatment accessurban healthcare

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