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HCV screening lags for women, blacks, Hispanics

While hepatitis C screening improved recently, the increased rates are minimal and less than optimal among black individuals, Hispanics and women, according to a recently published study.

“There is substantial room for improvement,” Monica L. Kasting, PhD, from the H. Lee Moffitt Cancer Center, Florida, and colleagues wrote. “The new screening guidelines are meant to augment, not replace risk-based guidelines, but if they are not properly implemented, half of those chronically infected with HCV may fail to be identified.”

To assess changes in HCV screening rates in the U.S., Kasting and colleagues analyzed data from the 2013, 2014 and 2015 National Health Interview Surveys, as these years immediately followed changes in national recommendations for screening and the greater availability of direct-acting antiviral therapy.

The researchers’ analysis included older survey participants born before 1945, baby boomers born between 1945 and 1965, participants born between 1966 and 1985, and the youngest participants born after 1985.

Over the 3 survey years, HCV screening rates were between 11.5% and 12.8% for baby boomers, between 13.7% and 14.9% for the second youngest birth cohort, and between 3.9% and 4.5% among the older participants. Less than 20% of participants indicated their age as the reason for HCV screening.

Among the youngest participants, increasing age (OR = 1.04; 95% CI, 1-1.07) correlated significantly with an increased likelihood for screening. Women were less likely to be screened (OR = 0.79; 95% CI, 0.66-0.95).

HCV screening increased significantly between 2013 and 2015 among the second youngest participants (OR = 1.2; 95% CI, 1.06-1.35). However, Midwest residents (OR = 0.78; 95% CI, 0.66-0.94) and women (OR = 0.66; 95% CI, 0.6-0.74) were less likely to be screened. Compared with white participants, black participants (OR = 0.7; 95% CI, 0.62-0.8), Asians (OR = 0.64; 95% CI, 0.5-0.83), and Hispanics (OR = 0.68; 95% CI, 0.59-0.78) were also less likely to be screened.

Screening increased significantly between 2013 and 2015 (OR = 1.31; 95% CI, 1.13-1.52) among baby boomers and correlated with increasing age (OR = 0.9; 95% CI, 0.85-0.94). Black participants (OR = 0.81; 95% CI, 0.69-0.94), Hispanics (OR = 0.79; 95% CI, 0.66-0.95), and women (OR = 0.71; 95% CI, 0.63-0.79) were still less likely to be screened.

Older survey participants who lived in the West were more likely to be screened for HCV (OR = 2; 95% CI, 1.39-2.88), while increasing age correlated with a decreased screening rate (OR = 0.85; 95% CI, 0.76-0.95). Women had the lowest rate of screening in the oldest cohort (OR = 0.71; 95% CI, 0.57-0.89).

Previous screening for HIV correlated significantly with higher odds for screening throughout the different birth cohorts. Having active health insurance or a health care provider was also significant among the second youngest cohort and the baby boomers. Colon cancer screening correlated with higher odds for HCV screening among the baby boomers and older participants.

The researchers noted an interest in colon cancer screening’s correlation with HCV screening, stating that colon cancer tests are typically performed by a gastroenterologist who may have a greater awareness of HCV risks, while it is usually a primary care physician who orders HCV tests.

“The stronger association between colon cancer screening and HCV screening was an unexpected finding that requires replication in other studies,” the researchers concluded. – by Talitha Bennett

Disclosure: Kasting reports no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.