Fear of a Liver Biopsy is the Primary Barrier Leading to Disparities in the Treatment and Outcomes of Hepatitis C in Somali Patients in Minnesota

Abstract

Introduction: The purpose of this study was to review the treatment and outcomes of Somali patients with hepatitis C (HCV) in 2 academic medical centers in Minnesota and to compare them to a control group of non-Somali patients in order to assess for disparities in treatment and/or outcomes. Methods: Somali patients were identified at each institution using ICD-9 codes for HCV (070.54 or 070.70) from September 2008 through August 2013. A control group of age and gender-matched patients was identified from the remaining non-Somali patients. Clinical data such as HCV treatment, reasons for lack of treatment, sustained virologic response (SVR) rates, and laboratory values were collected and compared. Results: We identified 142 Somali patients and 142 non-Somali controls that were age and gendermatched. Although Somali patients were offered treatment at similar rates as controls, a larger percentage of them declined treatment (17% vs 4%). The most significant barrier to treatment was refusal of liver biopsy (8% vs. 1%). Fear of side effects was also treatment-limiting for 8% of the Somali patients who were treatment candidates. Overall, 58% of Somali patients who were treatment candidates underwent treatment, vs. 77% of controls. Of the patients who underwent treatment, rates of SVR were similar (26% of Somalis vs. 23% of controls). Non-cirrhotic patients achieved SVR in 5-6% vs. 1% in cirrhotic patients regardless of ethnicity. There were more Somali patients (9% vs. 2%) that were co-infected with Hepatitis B. Genotype 1 was most common in 51% of the controls with an SVR rate of 23%. In Somalis, genotype 4 (35%) and 3 (23%) were the most common with SVR rates of 5% and 46%, respectively. Conclusion: We did not find significant differences in access to treatment, but fewer Somali patients accepted treatment. The most significant barriers to accepting treatment for Somalis were refusal of a liver biopsy and fear of treatment side effects. When the Somali patients were treated, their overall rates of SVR were similar to the non-Somali population. Genotype 4 and 3 were the most common in the Somali population, vs. genotype 1 in non-Somalis. Newer treatments may offer better outcomes for Somali patients with HCV. In the era of new interferon-free regimens and increasing use of noninvasive methods to assess liver fibrosis, we anticipate that HCV treatment outcomes in Somalis will improve. It is essential for healthcare providers to find interventions aimed at reducing the barriers to treatment and increasing acceptance of HCV treatment.