1285. Predictors of Testing for and Infection with Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) in Four United States Health Care Organizations (HCOs), 2006-2008
Session: Poster Abstract Session: Viral Epidemiology
Saturday, October 22, 2011
Room: Poster Hall B1
Background: In the U.S. about 65% and 75% of the infected population are unaware they are infected with HBV and HCV, respectively.  To examine testing practices, we determined factors associated with receiving a test and having a positive test result for HBV or HCV infection among persons enrolled in U.S. HCOs. 

Methods: Members age ≥18 yrs from 4 U.S. HCOs with: 1) ≥1 encounter from 1/1/2006-12/31/2008, 2) ≥12 months continuous enrollment (including pre-2006), and 3) no known HBV or HCV infection, were eligible for analysis.  Logistic regression, adjusted for length of coverage, was used to determine sociodemographic and clinical factors associated with testing (HBsAg, anti-HCV, and HCV RNA) and for having a positive result for HBV or HCV infection.  Risk factor data were unavailable. 

Results:  Of 1,248,558 members, 866,886 (69.4%) were eligible for HBV analysis (no known HBV infection) and 865,659 (69.3%) were eligible for HCV analysis (no known HCV infection).  Most were age <65 yrs (83%), women (54%), non-white (51%), non-Hispanic (98%), had income of $30-74K/yr (83%), and 19% had ≥1 prior abnormal alanine aminotransferase (ALT) level.   Of those eligible, 162,974 (18.8%) were tested for HBV infection, of whom 2326 (1.4%) tested positive; 109,939 (12.7%) were tested for HCV infection, of whom 6006 (5.5%) tested positive.  Members most likely tested had ≥1 prior abnormal ALT level (adjusted Odds Ratio [aOR] 3.73 for HBV and 5.34 for HCV, relative to normal ALT).  Compared to whites, Asians (aOR 6.13) and Native Hawaiian/Pacific Islanders (aOR 3.38) were most likely infected with HBV, whereas those aged 50-59, 40-49, and 60-69 yrs were most likely HCV-infected (aOR 6.03, 2.94, and 2.8, respectively, relative to age <30 yrs).  Based on U.S. prevalence estimates of anti-HCV (1.6%, unadjusted for our study population), approximately 43% (6006) of 13,850 predicted HCV infections among eligible members were identified.  

Conclusion:  In this large cohort without risk factor data, clinical factors (i.e., ALT level) were associated with testing, whereas sociodemographic characteristics (race for HBV and age group for HCV) were strongly associated with infection.  Strategies for testing based on age may improve detection of HCV infection. 


Subject Category: V. Virology including clinical and basic studies of viral infections, including hepatitis

Philip Spradling1, Loralee Rupp2, Anne Moorman1, Mei Lu2, Eyasu Teshale1, Stuart Gordon2, Cynthia Nakasato3, Joseph Boscarino4, Emily Henkle5, David Nerenz2 and Scott Holmberg, MD, MPH1, (1)Division of Viral Hepatitis, CDC, Atlanta, GA, (2)Henry Ford Health System, Detroit, MI, (3)Kaiser Permanente Center for Health Research, Hawaii, Honolulu, HI, (4)Center for Health Research, Geisinger Health System, Danville, PA, (5)The Center for Health Research, Kaiser Permanente Northwest, Portland , OR

Disclosures:

P. Spradling, None

L. Rupp, None

A. Moorman, None

M. Lu, None

E. Teshale, None

S. Gordon, Abott Phramaceuticals: Grant Investigator, Research grant
Anadys Phramaceuticals: Grant Investigator, Research grant
Bristol-Myers Squibb: Consultant and Grant Investigator, Consulting fee and Research grant
Conatus: Grant Investigator, Research grant
Eiger Biopharmaceuticals Inc: Grant Investigator, Research grant
Exalenz BioScience: Grant Investigator, Research grant
Gilead Pharamceuticals: Consultant, Grant Investigator and Speaker's Bureau, Consulting fee, Research grant and Speaker honorarium
GlaxoSmithKline: Research Contractor, Research grant
GlobeImmune: Grant Investigator, Research grant
Intercept Pharmaceuticals: Grant Investigator, Research grant
Merck: Consultant, Grant Investigator and Speaker's Bureau, Consulting fee, Research grant and Speaker honorarium
Roche Pharmaceuticals: Grant Investigator and Speaker's Bureau, Research grant and Speaker honorarium
Tibotec: Grant Investigator and Scientific Advisor, Research grant
Vertex Pharmaceuticals: Consultant, Grant Investigator and Speaker's Bureau, Consulting fee, Research grant and Speaker honorarium
Zymogenetics: Grant Investigator, Research grant
Achillion: Consultant, Consulting fee
CVS Caremark: Consultant, Consulting fee
Salix Pharmaceuticals: Consultant, Consulting fee
Johnson and Johnson: Consultant, Consulting fee
Bayer: Speaker's Bureau, Speaker honorarium

C. Nakasato, None

J. Boscarino, None

E. Henkle, None

D. Nerenz, None

S. Holmberg, None

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