Do patients at high risk for Hepatitis C receive recommended testing? A retrospective cohort study of statewide Medicaid claims linked with OneFlorida clinical data

Rahma S. Mkuu, Elizabeth A. Shenkman, Keith E. Muller, Tianyao Huo, Ramzi G. Salloum, Roniel Cabrera, Ali Zarrinpar, Emmanuel Thomas, Sarah M. Szurek, David R. Nelson

Research output: Contribution to journalArticlepeer-review

Abstract

Hepatitis C virus (HCV) infection is a leading risk factor for hepatocellular carcinoma. We employed a retrospective cohort study design and analyzed 2012–2018 Medicaid claims linked with electronic health records data from the OneFlorida Data Trust, a statewide data repository containing electronic health records data for 15.07 million Floridians from 11 health care systems. Only adult patients at high-risk for HCV (n = 30,113), defined by diagnosis of: HIV/AIDS (20%), substance use disorder (64%), or sexually transmitted infections (22%) were included. Logistic regression examined factors associated with meeting the recommended sequence of HCV testing. Overall, 44.1% received an HCV test. The odds of receiving an initial test were significantly higher for pregnant females (odds ratio [OR]1.99; 95% confidence interval [CI] 1.86–2.12; P < .001) and increased with age (OR 1.01; 95% CI 1.00–1.01; P < .001).Among patients with low Charlson comorbidity index (CCI = 1), non-Hispanic (NH) black patients (OR 0.86; 95% CI 0.81–0.9; P < .001) had lower odds of getting an HCV test; however, NH black patients with CCI = 10 had higher odds (OR 1.41; 95% CI 1.21–1.66; P < .001) of receiving a test. Of those who tested negative during initial testing, 17% received a second recommended test after 6 to 24 months. Medicaid-Medicare dual eligible patients, those with high CCI (OR 1.14; 95% CI 1.11–1.17; P < .001), NH blacks (OR 1.93; 95% CI 1.61–2.32; P < .001), and Hispanics (OR 1.49; 95% CI 1.08–2.06; P = .02) were significantly more likely to have received a second HCV test, while pregnant females (OR 0.71; 95% CI 0.57–0.89; P = .003), had lower odds of receiving it. The majority of patients who tested positive during the initial test (97%) received subsequent testing. We observed suboptimal adherence to the recommended HCV testing among high-risk patients underscoring the need for tailored interventions aimed at successfully navigating high-risk individuals through the HCV screening process. Future interventional studies targeting multilevel factors, including patients, clinicians and health systems are needed to increase HCV screening rates for high-risk populations.

Original languageEnglish (US)
Pages (from-to)E28316
JournalMedicine (United States)
Volume100
Issue number50
DOIs
StatePublished - Dec 17 2021
Externally publishedYes

Keywords

  • Cancer screening
  • HCV
  • Hepatitis C
  • Hepatitis C testing
  • Hepatocellular carcinoma

ASJC Scopus subject areas

  • Medicine(all)

Fingerprint

Dive into the research topics of 'Do patients at high risk for Hepatitis C receive recommended testing? A retrospective cohort study of statewide Medicaid claims linked with OneFlorida clinical data'. Together they form a unique fingerprint.

Cite this