Delayed Diagnosis of Hepatitis C Infection: Results of a Nationwide US Study

Universal screening of hepatitis C virus (HCV) was encouraged for individuals born 1945-65 in the USA in 2012. In 2014, efficacious treatments, namely, direct-acting antivirals (DAAs), were introduced. To examine their impact on the HCV care cascade, the proportion of and factors associated with delayed HCV diagnosis in the USA were examined in a national real-world cohort.

We retrospectively analyzed 69,989 adults with an HCV-related liver complication using the Merative™ Marketscan® Medicare Database (1/2007-12/2021). We defined delayed HCV diagnosis as a HCV diagnosis 2 years prior to or any time after the development of a liver complication, including cirrhosis, liver transplant, or hepatocellular carcinoma.

The cohort mean age was 55.8 years, 65.9% were male, and the vast majority (60,628 or 86.6%) had delayed HCV diagnosis with 47.7% occurring within 6 months of the complication. The proportion of delayed HCV diagnosis decreased from 89.1% before 2015 to 75.1% from 2015 to 2021. On multivariable analysis, complication diagnosis dates after 2015 and higher Charlson Comorbidity Index were associated with decreased odds of delayed HCV diagnosis, while male sex, mental health, and alcohol use were linked with increased odds of delayed HCV diagnosis.

Delayed HCV diagnosis occurred in almost 9 in 10 patients with chronic hepatitis C and liver complications overall and in 3 out of 4 even after DAA availability during the 2015-2021 time period. Further efforts are needed to improve HCV screening and linkage to care.