Souvik Sarkar1, Denise A Esserman2, Melissa Skanderson3, Forrest L Levin4, Amy C Justice5, Joseph K Lim6. 1. Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA; Current affiliation: Division of Gastroenterology and Hepatology, University of California, Davis, CA, USA. 2. Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA. 3. VA Pittsburgh Healthcare System, Pittsburgh, PA, USA. 4. Department of Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA. 5. Department of Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA; Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA. 6. Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA. Electronic address: joseph.lim@yale.edu.
Abstract
BACKGROUND & AIMS: Universal one-time antibody testing for hepatitis C virus (HCV) infection has been recommended by the centers for disease control (CDC) and the United States preventative services task force (USPSTF) for Americans born 1945-1965 (birth cohort). Limited data exists addressing national HCV testing practices. We studied patterns and predictors of HCV testing across the U.S. within the birth cohort utilizing data from the national corporate data warehouse of the U.S. Veterans Administration (VA) health system. METHODS: Testing was defined as any HCV test including antibody, RNA or genotype performed during 2000-2013. RESULTS: Of 6,669,388 birth cohort veterans, 4,221,135 (63%) received care within the VA from 2000-2013 with two or more visits. Of this group, 2,139,935 (51%) had HCV testing with 8.1% HCV antibody and 5.4% RNA positive. Significant variation in testing was observed across centers (range: 7-83%). Older, male, African-Americans, with established risk factors and receiving care from urban centers of excellence were more likely to be tested. Among veterans free of other established risk factors (HIV negative, HBV negative, ALT ⩽40U/L, FIB-4 ⩽1.45, or APRI <0.5), HCV antibody and RNA were positive in 2.8% and 0.9%, respectively, comparable to established national average. At least 2.4-4.4% of veterans had scores suggesting advanced fibrosis (APRI ⩾1.5 or FIB-4 >3.25) with >30-43% having positive HCV RNA but >16-20% yet to undergo testing for HCV. CONCLUSIONS: Significant disparities are observed in HCV testing within the United States VA health system. Examination of the predictors of testing and HCV positivity may help inform national screening policies. LAY SUMMARY: Analysis of United States Veterans Administration data show significant disparities in hepatitis C virus testing of veterans born 1945-1965 (birth cohort). A fifth of those not tested had evidence of advanced liver fibrosis. Our data suggests some predictors for this disparity and will potentially help inform future policy measures in the era of universal birth cohort testing for HCV.
BACKGROUND & AIMS: Universal one-time antibody testing for hepatitis C virus (HCV) infection has been recommended by the centers for disease control (CDC) and the United States preventative services task force (USPSTF) for Americans born 1945-1965 (birth cohort). Limited data exists addressing national HCV testing practices. We studied patterns and predictors of HCV testing across the U.S. within the birth cohort utilizing data from the national corporate data warehouse of the U.S. Veterans Administration (VA) health system. METHODS: Testing was defined as any HCV test including antibody, RNA or genotype performed during 2000-2013. RESULTS: Of 6,669,388 birth cohort veterans, 4,221,135 (63%) received care within the VA from 2000-2013 with two or more visits. Of this group, 2,139,935 (51%) had HCV testing with 8.1% HCV antibody and 5.4% RNA positive. Significant variation in testing was observed across centers (range: 7-83%). Older, male, African-Americans, with established risk factors and receiving care from urban centers of excellence were more likely to be tested. Among veterans free of other established risk factors (HIV negative, HBV negative, ALT ⩽40U/L, FIB-4 ⩽1.45, or APRI <0.5), HCV antibody and RNA were positive in 2.8% and 0.9%, respectively, comparable to established national average. At least 2.4-4.4% of veterans had scores suggesting advanced fibrosis (APRI ⩾1.5 or FIB-4 >3.25) with >30-43% having positive HCV RNA but >16-20% yet to undergo testing for HCV. CONCLUSIONS: Significant disparities are observed in HCV testing within the United States VA health system. Examination of the predictors of testing and HCV positivity may help inform national screening policies. LAY SUMMARY: Analysis of United States Veterans Administration data show significant disparities in hepatitis C virus testing of veterans born 1945-1965 (birth cohort). A fifth of those not tested had evidence of advanced liver fibrosis. Our data suggests some predictors for this disparity and will potentially help inform future policy measures in the era of universal birth cohort testing for HCV.
Authors: Lisa I Backus; Derek B Boothroyd; Barbara R Phillips; Pamela Belperio; James Halloran; Larry A Mole Journal: Clin Gastroenterol Hepatol Date: 2011-03-11 Impact factor: 11.382
Authors: Shawn L Fultz; Melissa Skanderson; Larry A Mole; Neel Gandhi; Kendall Bryant; Stephen Crystal; Amy C Justice Journal: Med Care Date: 2006-08 Impact factor: 2.983
Authors: Eric Lawitz; Alessandra Mangia; David Wyles; Maribel Rodriguez-Torres; Tarek Hassanein; Stuart C Gordon; Michael Schultz; Mitchell N Davis; Zeid Kayali; K Rajender Reddy; Ira M Jacobson; Kris V Kowdley; Lisa Nyberg; G Mani Subramanian; Robert H Hyland; Sarah Arterburn; Deyuan Jiang; John McNally; Diana Brainard; William T Symonds; John G McHutchison; Aasim M Sheikh; Zobair Younossi; Edward J Gane Journal: N Engl J Med Date: 2013-04-23 Impact factor: 91.245
Authors: Adriaan J van der Meer; Bart J Veldt; Jordan J Feld; Heiner Wedemeyer; Jean-François Dufour; Frank Lammert; Andres Duarte-Rojo; E Jenny Heathcote; Michael P Manns; Lorenz Kuske; Stefan Zeuzem; W Peter Hofmann; Robert J de Knegt; Bettina E Hansen; Harry L A Janssen Journal: JAMA Date: 2012-12-26 Impact factor: 56.272
Authors: Basile Njei; Denise Esserman; Supriya Krishnan; Michael Ohl; Janet P Tate; Ronald G Hauser; Tamar Taddei; Joseph Lim; Amy C Justice Journal: Med Care Date: 2019-04 Impact factor: 2.983
Authors: Albert Do; Denise A Esserman; Supriya Krishnan; Joseph K Lim; Tamar H Taddei; Ronald G Hauser; Janet P Tate; Vincent Lo Re; Amy C Justice Journal: J Gen Intern Med Date: 2020-04-27 Impact factor: 5.128
Authors: Julie A Womack; Terrence E Murphy; Harini Bathulapalli; Alexandria Smith; Jonathan Bates; Samah Jarad; Nancy S Redeker; Stephen L Luther; Thomas M Gill; Cynthia A Brandt; Amy C Justice Journal: J Am Geriatr Soc Date: 2020-08-28 Impact factor: 5.562
Authors: Jun Li; Carl Armon; Frank J Palella; Ellen Tedaldi; Richard M Novak; Jack Fuhrer; Gina Simoncini; Kimberly Carlson; Kate Buchacz Journal: Open Forum Infect Dis Date: 2021-04-17 Impact factor: 3.835
Authors: Joshua A Barocas; Jianing Wang; Laura F White; Abriana Tasillo; Joshua A Salomon; Kenneth A Freedberg; Benjamin P Linas Journal: Health Aff (Millwood) Date: 2017-12 Impact factor: 9.048
Authors: Amoah Yeboah-Korang; Mohammad I Beig; Mohammad Q Khan; Jay L Goldstein; Don M Macapinlac; Darryck Maurer; Amnon Sonnenberg; Claus J Fimmel Journal: J Transl Int Med Date: 2018-06-26
Authors: Jessie Torgersen; Craig W Newcomb; Dena M Carbonari; Christopher T Rentsch; Lesley S Park; Alyssa Mezochow; Rajni L Mehta; Lynn Buchwalder; Janet P Tate; Norbert Bräu; Debika Bhattacharya; Joseph K Lim; Tamar H Taddei; Amy C Justice; Vincent Lo Re Journal: J Hepatol Date: 2021-07-29 Impact factor: 30.083