Sociodemographic disparities in Hepatitis C care utilization and testing in the United States

Hepatitis C infection (HCV) is a leading cause of liver disease and mortality. Despite curative treatment options, HCV elimination remains elusive. Although the US has national screening and treatment recommendations, HCV remains under-screened and under-diagnosed. We utilized two national surveys to estimate trends in overall HCV care utilization and testing in the US.

Data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey from 2010 to 2019 were analyzed using inverse probability weighting to generate national estimates of visits and testing. Weighted chi-square and logistic regression analyses adjusted for demographics, payor type, and time assessed the primary outcome of ambulatory care utilization and the secondary outcome of office-based hepatitis C screening.

Between 2010-2019, 23,469,344 HCV ambulatory visits are identified with higher overall adjusted visit rates for men (OR 1.54), people born 1945-1965 (OR 4.00), and insured by Medicare (OR 1.98) with increased utilization by White, privately insured patients in the office since 2016. HCV cases with Medicaid (OR 6.05) or have associated substance use disorder (SUD) (OR 3.30) are more likely to utilize the ER than office care. Screening rates are low in initial (2%) and overall (1%) primary care health visits.

In a nationally representative study, we find increasing rates of HCV visits, largely in White, privately insured patients seen in office. Low screening rates and disproportionate ER utilization among rural, racial/ethnic minorities, Medicaid insured, and patients with SUD highlight the importance of policy and practice guideline updates to improve identification and care linkage for HCV.