527. Mental Health, Heart Disease, and Lack of Insurance Associated with Not Receiving Hepatitis C Treatment in Safety-Net Hospitals
Session: Poster Abstract Session: Hepatitis B and C in Varied Settings
Thursday, October 5, 2017
Room: Poster Hall CD
Posters
  • PosterIDSA2017 10.9.17.pdf (558.6 kB)
  • Background: Those in safety-net hospitals are especially vulnerable to lack of access to specialty care and curative treatment (Tx) for hepatitis C (HCV). We examined predictors of receiving HCV Tx in safety-net hospitals.

    Methods: We retrospectively examined all adults who received care 1/1/11-2/28/17 in our two safety-net hospitals in California and Texas and had a diagnosis of HCV. We examined age, race/ethnicity, gender, insurance status, body mass index, liver-related complications (heptocelluar cancer (HCC), cirrhosis, ascites, non-alcoholic fatty liver disease, (NAFLD) hepatic encephalopathy, variceal bleeding) non-liver related co-morbidities [HIV, non-HCC cancers, mental health, cardiovascular disease (CVD), hypertension (HTN), diabetes (DM)] alcohol use, and drug use. We evaluated the predictors of receiving HCV Tx using multivariate logistic regression models.

    Results: Among 14,776 HCV patients in the study, most of the HCV patients (61% male, 43% Black, and 16% Hispanic) had Indigent care (42%), Medicare (14%), and Medicaid (27%). Co-morbidities in this population included mental health (71%), CVD (60%), HTN (51%), DM (21%), and HIV (9%). Indigent care, mental health and CVD co-morbidities were associated with lower rates of HCV Tx but Other race and NAFLD were associated with higher rates of Tx (see Table 1).

    Table 1: Logistic regression results predicting HCV TX in Safety Net Hospitals in Texas and California

    Total (n=14,776)

    N (%)

    HCV TX (n=646)

    N (%)

    OR

    95% Confidence Interval

    White (ref)

    Black

    6339 (42.9)

    245 (37.9)

    0.98

    0.80-1.19

    Other

    152 (1.0)

    34 (5.3)

    1.52

    1.10-2.09

    Hispanic

    2330 (15.8)

    120 (18.6)

    1.07

    0.84-1.35

    Commercial (ref)

    Medicare

    2032 (13.8)

    87 (13.5)

    0.70

    0.47-1.04

    Medicaid

    3927 (26.6)

    162 (25.1)

    0.78

    0.55-1.10

    Indigent

    6217 (42.1)

    244 (37.8)

    0.63

    0.44-0.88

    HIV

    1380 (9.3)

    71 (11)

    1.29

    0.98-1.68

    Mental Health

    10,507 (71.1)

    403 (62.4)

    0.82

    0.67-0.99

    NAFLD

    443 (3)

    26 (4)

    1.65

    1.04-2.61

    Cirrhosis

    2631 (17.8)

    122 (18.9)

    0.96

    0.76-1.22

    CAD

    8820 (59.7)

    297 (46)

    0.56

    0.47-0.68

    Conclusion: In our safety-net hospitals only 4.4% received HCV Tx. Those with indigent funding, mental illness or cardiac disease were significantly less likely to receive HCV Tx. These data indicate that certain populations are less likely to have access to HCV care. The reasons for this remains unknown. If we are to move towards HCV elimination, we must find strategies to increase access.

    Mamta K Jain, MD, MPH1,2, Robert Wong, MD3, Onkar Kshirsagar, MS4, Christopher Clark, MPA2 and Mae Thamer, PhD4, (1)Internal Medicine, Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, TX, (2)Parkland Health and Hospital System, Dallas, TX, (3)Internal Medicine, Alameda Health System-Highland Hospital, Oakland, CA, (4)Medical Technology and Practice Patterns Institute, Bethesda, MD

    Disclosures:

    M. K. Jain, Gilead: Grant Investigator , Research grant and Research support
    Merck: Grant Investigator , Research grant

    R. Wong, Gilead Sciences: Grant Investigator , Research grant

    O. Kshirsagar, None

    C. Clark, None

    M. Thamer, None

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