在城市学术医疗中心治疗C型肝炎的种族和社会人口差异,2018-2023年
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
概括
黑人,无家可归者和无保险患者的肝炎C病毒 (HCV) 治疗开始率较低,尽管有有效的治疗方法. 这些差异加剧了边缘化社区的肝病负担.
科学领域:
- 肝病学和传染病的研究
- 医疗保健服务研究 医疗服务研究
- 健康 公平 卫生 公平
背景情况:
- 肝炎C病毒 (HCV) 在美国不成比例地影响种族少数群体和社会弱势群体.
- 直接作用抗病毒疗法 (DAA) 提供高效的HCV治疗,但在治疗开始方面仍然存在显著的差异.
- 了解治疗开始的预测因素对于解决这些不平等问题至关重要.
研究的目的:
- 在多样化的患者队列中确定HCV治疗启动的社会人口统计和临床预测因素.
- 根据种族,保险状况和住房稳定性来量化直接作用抗病毒 (DAA) 处方率的差异.
- 为旨在减少HCV治疗不平等的有针对性的干预提供信息.
主要方法:
- 使用来自城市学术医疗中心的电子病历数据进行回顾性队列研究 (2018年10月2023年10月).
- 包括标准:具有阳性HCVRNA的个体.
- 多变量后勤回归分析以确定HCV治疗启动的预测因素 (定义为DAA处方).
主要成果:
- 在4345人中,有1150人 (26.5%) 接受了HCV治疗.
- 与白人相比,黑人患者开始治疗的几率较低 (aOR,0.68).
- 在无家可归 (aOR,0.57),医疗补助 (aOR,0.82) 或无保险 (aOR,0.49) 的人群中,观察到较低的治疗开始几率.
- 患有精神健康诊断的个人治疗开始的几率更高 (aOR,1.34).
- 没有接受治疗的患者在住院和急诊室的访问率更高.
结论:
- 在HCV治疗开始方面存在显著的差异,特别影响黑人,无家可归者和有公共保险或没有保险的人.
- 这些不平等造成了更多的肝病负担和边缘化群体的可预防死亡率.
- 解决健康的社会决定因素对于实现公平的HCV治疗结果至关重要.
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