Mental Health, Heart Disease, and Lack of Insurance Associated with Not Receiving Hepatitis C Treatment in Safety-Net Hospitals

Abstract

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.ResultsAmong 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)Black6339 (42.9)245 (37.9)0.980.80–1.19Other152 (1.0)34 (5.3) 1.52 1.10–2.09 Hispanic2330 (15.8)120 (18.6)1.070.84-1.35Commercial (ref)Medicare2032 (13.8)87 (13.5)0.700.47-1.04Medicaid3927 (26.6)162 (25.1)0.780.55-1.10Indigent6217 (42.1)244 (37.8) 0.63 0.44-0.88 HIV1380 (9.3)71 (11)1.290.98-1.68Mental Health10,507 (71.1)403 (62.4) 0.82 0.67-0.99 NAFLD443 (3)26 (4) 1.65 1.04-2.61 Cirrhosis2631 (17.8)122 (18.9)0.960.76-1.22CAD8820 (59.7)297 (46) 0.56 0.47-0.68 ConclusionIn 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.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