Health Services Research & Development

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2006 HSR&D National Meeting Abstract


1009 — Racial Differences in the Evaluation and Treatment of Hepatitis C: A Retrospective Cohort Study

Author List:
Rousseau CM (Northwest HSR&D Center of Excellence, VA Puget Sound HCS, Seattle, WA)
Ioannou GN (Seattle Epidemiologic Research and Information Center, VA Puget Sound HCS, Seattle, WA)
Todd-Stenberg JA (Northwest HSR&D Center of Excellence, VA Puget Sound HCS, Seattle, WA)
Sloan KL (Northwest HSR&D Center of Excellence, VA Puget Sound HCS, Seattle, WA)
Dominitz JA (Northwest HSR&D Center of Excellence, VA Puget Sound HCS, Seattle, WA)

Objectives:
Although anti-viral therapy is available for hepatitis C virus infection, only a minority of patients undergoes treatment. Race has been shown to be associated with receipt of medical care for various medical conditions. The aim of this study was to examine the association between race and hepatitis C treatment.

Methods:
This retrospective cohort study used medical records to determine anti-viral treatment of 4,263 hepatitis C infected patients from all eight Department of Veterans Affairs Medical Centers in VISN 20. Secondary outcome measures included referral to specialty clinic, complete laboratory evaluation, genotype testing, and liver biopsy. Multiple logistic regression was used to adjust for clinical and socio-demographic factors.

Results:
Among those without apparent contraindications to therapy, Blacks were significantly less likely than Whites to receive anti-viral therapy (4.5% versus 13.7%; adjusted odds ratio [OR] 0.38; 95% confidence interval [CI] 0.23 - 0.64). Among those whose virus was genotyped, Blacks remained significantly less likely to be treated, independent of genotype (14.6% versus 34.2%; adjusted OR, 0.48; 95% CI 0.25 - 0.92). Blacks and Whites had similar odds of referral to specialty clinics and of undergoing liver biopsy. However, Blacks were significantly less likely to have complete laboratory evaluation (23.5% versus 28.4%; adjusted OR, 0.70; 95% CI, 0.54 - 0.91) and viral genotyping (22.5% versus 30.5%; adjusted OR, 0.69; 95% CI, 0.51 - 0.93).

Implications:
Blacks were less likely than Whites to be evaluated and receive anti-viral treatment for hepatitis C.

Impacts:
Given that Blacks are disproportionately affected by hepatitis C infection in the United States, it is especially important to assure equal access to health care services for this infection. Clearly, further research is needed to understand the underlying explanations for these findings and to help develop interventions at the patient, provider, and/or system level as appropriate.