Sociodemographic Disparities in Hepatitis C Care Utilization and Testing in the United States: A Nationwide Survey Analysis

Introduction Hepatitis C infection (HCV) is a leading cause of liver disease and mortality. Despite curative treatment options, eradication remains elusive. Although the US has national screening 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. Methods Data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey from 2010-2019 were analyzed via 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 as well as the secondary outcome of office-based hepatitis C screening. Results Between 2010-2019, 23,469,344 HCV ambulatory visits were 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. Identified HCV cases who were covered by Medicaid (OR 6.05) or had associated substance use disorder (SUD) (OR 3.30) were more likely to utilize the ER than office care. Since 2016 per-visit screening rates were low both overall (1%) and when restricting to initial primary care preventive health visits (2.1%). Discussions In a nationally representative study of ambulatory care utilization, we identified increasing rates of HCV visits, largely in White privately insured patients seen in office. Low overall screening rates and disproportionate ER utilization among rural, racial/ethnic minorities, Medicaid insured and patients with SUD highlight the importance of updated policy and practice guidelines to improve identification and care linkage for HCV.