Comorbidities Associated With Chronic Hepatitis C Among Medicaid Beneficiaries, 2016-2020

Understanding comorbidities of chronic hepatitis C is crucial for improving care for affected persons. The prevalence of comorbidities associated with chronic hepatitis C among Medicaid beneficiaries is reported.

A descriptive retrospective cohort study was conducted using Centers for Medicare & Medicaid Services 2016-2021 data of Medicaid beneficiaries aged 18-64 years with a chronic hepatitis C diagnosis, not dually enrolled in Medicare, and with ≥12 months of continuous enrollment after diagnosis. The prevalence of comorbidity diagnoses (HIV, chlamydia, gonorrhea, syphilis, mental health disorders, substance use disorders, overdoses, and alcohol poisonings) was estimated within 12 months after the chronic hepatitis C diagnosis date. Results were stratified by younger (18-44 years) and older (45-64 years) age groups. Multivariable log-binomial regression was used to generate adjusted prevalence ratios for each comorbidity to compare between age groups.

Among enrolled Medicaid beneficiaries, 487,413 had diagnosed chronic hepatitis C. Those aged 18-44 years (n=198,086) were more likely to be female (54%) than those aged 45-64 years (40%; n=289,327). The highest prevalences of comorbidity diagnoses were any substance use disorder (53%) and any mental health disorder (50%). In adjusted models, beneficiaries aged 18-44 years were less likely to have an HIV diagnosis (adjusted prevalence ratio=0.56; 95% CI=0.43, 0.74) than those aged 45-64 years. Conversely, younger beneficiaries were more likely to be diagnosed with other comorbidities, including chlamydia (adjusted prevalence ratio=5.72; 95% CI=4.54, 7.19) and any overdose or alcohol poisoning (adjusted prevalence ratio=2.09; 95% CI=1.95, 2.24).

Approximately half of the Medicaid beneficiaries with diagnosed chronic hepatitis C had a mental health disorder or a substance use disorder. Younger beneficiaries had higher prevalences of comorbidities than older beneficiaries, excluding HIV. Prioritizing and supporting evidence-based programs that provide comprehensive services for Medicaid beneficiaries with hepatitis C and comorbid diagnoses may help beneficiaries address multiple conditions more effectively.