10-year trends in the diagnosis and treatment of hepatitis C and concomitant mental health disorders: 1995 to 2005

Abstract

Objective: To evaluate trends in the rate and timing of treatment for hepatitis C in those with and without mental health comorbidities.

Method: Data from the population-based Olmsted County Hepatitis C Registry in Minnesota were linked to patients' medical records to identify the dates and duration of any hepatitis C-specific therapy as well as all diagnoses of mental health comorbid conditions prior to initiation of therapy. The most common mental health conditions, major depressive disorder, alcohol dependence, and intravenous drug use, were assessed separately. The registry includes all Olmsted County residents with a physician diagnosis of hepatitis C or non-A/non-B hepatitis (ICD-9 criteria) from January 1, 1990, through December 31, 2005.

Results: The age-adjusted prevalence of diagnosed hepatitis C increased markedly between 1995 and 2000 (15.5/10,000 persons to 27.0/10,000 persons) but changed little between 2000 and 2005 (27.0 to 27.9/10,000 persons). The number of people with comorbid hepatitis C and depressive disorder (including minor depression) increased significantly between 1995 and 2005 from 18% to over 35% of all people with diagnosed hepatitis C. Treatment rates more than doubled between 1995 and 2005, while the time from diagnosis to treatment decreased during that same period. By 2005, major depressive disorders were associated with a high rate of reasonably prompt treatment. There were no gender differences in treatment rates or time to treatment when other comorbidities and age were included in the analyses.

Conclusions: From 1995 to 2005, rates of treatment for hepatitis C among people with and without comorbid mental health problems increased. Rates of increase were higher among those with depression and hepatitis C than among those with hepatitis C and drug abuse or other mental health diagnoses. Even with this progress in treating those with multiple diagnoses, over 75% of people with hepatitis C remain untreated.

Figure 1

Incidence Rates of Hepatitis C and Percentage of Patients Treated

Figure 2

Trends in Time From Diagnosis to Treatment of Hepatitis C in all Cases

Figure 3

Recent Trends in Time From Diagnosis to Treatment of Hepatitis C: 2000–2004

Figure 4

Treatment Rates Among Hepatitis C Patients With and Without Comorbid Mental Health Conditions^{a a}A = no depression, drug use, or alcohol dependence; B = major depressive disorders; C = intravenous drug use without depression; and D = alcohol dependence without drug use or depression.