番茄社区

WASHINGTON -- Adults with hepatitis C virus (HCV) were more likely to die if they were on Medicaid than other insurance plans, while uninsured HCV-infected adults also exhibited higher mortality rates, according to researchers here.

Being HCV-positive significantly correlated with higher mortality rates (10.4% versus 3.1% of HCV-negative patients, P<0.0001), as did age, male sex, marital status, education, and the presence of several medical comorbidities, reported Haley Bush, MSPH, of Inova Health System in Falls Church, Virginia, and colleagues.

HCV patients were more likely to have public insurance or be uninsured versus being privately insured. The presence of HCV significantly and independently increased mortality (HR 2.04, 95% CI 1.17 to 3.35), particularly among patients on Medicaid (HR 9.64, 95% CI 1.66 to 55.97), they reported at Digestive Disease Week.

In addition, Medicaid patients were more likely to be HCV-positive, and HCV infection was highest among those without insurance. HCV-positive Medicaid patients also manifested higher rates of comorbidities such as diabetes, congestive heart failure, and stroke (P<0.05).

"We want policymakers to mobilize towards a national treatment policy for hepatitis C, consistent with the [World Health Organization]," said co-author Zobair M. Younossi, MD, MPH, of Inova Fairfax Hospital in Falls Church, Virginia, to 番茄社区. "All patients with hepatitis C should be treated."

The researchers queried the from 2000-2010 and found 311 people with HCV (1.4%) out of 19,452 total participants. Being older, black, male, unmarried, unemployed, and a smoker all significantly predicted HCV presence.

They used Cox proportional hazards models to evaluate independent associations of HCV and insurance type with mortality. Focusing on the HCV-positive respondents only, they re-ran the analysis to divulge associations between insurance type and mortality.

Participants on two or more insurance plans were excluded from the study, as were children, and those who did not complete questionnaires on insurance type or HCV test results.

Participants were considered to be HCV-positive if their serum tested positive for HCV RNA.

"Although having public insurance (compared to private insurance) increases the risk of mortality in HCV infected patients, it is mainly coverage with Medicaid that is an independent predictor of mortality among HCV+ patients," according to the researchers. "These data should inform policy makers to provide adequate coverage and access to care for HCV infected patients who are covered by public insurance in the U.S."

Bush pointed out that to HCV medication remains a problem among Medicaid patients. "Further research is warranted to assess the impact of Medicaid expansion, and the new anti-viral regimens, and for HCV treatment after 2010," Bush stated.

Younossi said the researchers plan to assess if new HCV treatment regimens "have changed the paradigm."

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