Racial Disparities in Treatment Rates for Chronic Hepatitis C: Analysis of a Population-Based Cohort of 73,665 Patients in the United States

Abstract

Chronic hepatitis C (CHC) disproportionately affects racial minorities in the United States (US). Although prior studies have reported lower treatment rates in Blacks than in Caucasians, the rates of other minorities remain understudied. We aimed to examine antiviral treatment rates by race and to evaluate the effect of other demographic, medical, and psychiatric factors on treatment rates. We performed a population-based study of adult CHC patients identified via ICD-9CM query from OptumInsight's Data Mart from January 2009 to December 2013. Antiviral treatment was defined by pharmaceutical claims for interferon and/or pegylated-interferon. A total of 73,665 insured patients were included: 51,282 Caucasians, 10,493 Blacks, 8679 Hispanics, and 3211 Asians. Caucasians had the highest treatment rate (10.7%) followed by Blacks (8.8%), Hispanics (8.8%), and Asians (7.9%, P < .001). Hispanics had the highest cirrhosis rates compared with Caucasians, Blacks, and Asians (20.7% vs 18.3%, 17.1%, and 14.3%, respectively). Caucasians were the most likely to have a psychiatric comorbidity (20.1%) and Blacks the most likely to have a medical comorbidity (44%). Asians were the least likely to have a psychiatric (6.4%) or medical comorbidity (26.9%). On multivariate analysis, racial minority was a significant predictor of nontreatment with odds ratios of 0.82 [confidence interval (CI): 0.74-0.90] for Blacks, 0.87 (CI: 0.78-0.96) for Hispanics, and 0.73 (CI: 0.62-0.86) for Asians versus Caucasians. Racial minorities had lower treatment rates than Caucasians. Despite fewer medical and psychiatric comorbidities and higher incomes and educational levels, Asians had the lowest treatment rates. Hispanics also had lower treatment rates than Caucasians despite having higher rates of cirrhosis. Future studies should aim to identify underlying racial-related barriers to hepatitis C virus treatment besides socioeconomic status and medical or psychiatric comorbidities.

FIGURE 1

Number of antiviral prescriptions from January 2009 to June2011 (before introduction of protease inhibitors) and June 2011 to December 2013 (after the introduction of protease inhibitors). N = 3988 in the pre-protease inhibitor period and n = 3442 (2252 prescriptions of triple therapy and 1190 of dual therapy) in the post-protease inhibitor period.

FIGURE 2

Treatment rates across the study period as stratified by ethnicity and gender. In both genders, Caucasians had the highest treatment rates and Asians had the lowest (P = 0.001). Caucasian males had the highest treatment rates (11.3%), whereas Asian females had the lowest treatment rates (6.9%).

FIGURE 3

Antiviral treatment persistency rates by race. The blue curve represents Caucasians, green curve Hispanics, brown curve Blacks, and orange curve Asians. At 24 weeks, nearly two-thirds of patients dropped out of treatment and only 41.3% remained persistent.