Education, Income, Insurance Influence Hepatitis C Virus Testing for Ethnic, Racial Groups

Data from a national survey on community health in racial and ethnic groups suggest specific socioeconomic barriers to hepatitis C virus detection and therapy.

Within certain racial and ethnic groups, insurance, age, education level, and annual income significantly impact hepatitis C virus (HCV) testing and treatment, the results of a study published in the January 2013 edition of the American Journal of Public Health suggest.

In particular, age and possessing health insurance were significant factors determining whether a physician followed participants after HCV diagnosis, the researchers noted. In addition, participants 45 years or older were more likely to have received medication for HCV.

Income also had a significant influence on medication therapy, as participants with annual household incomes of $50,000 or greater had higher odds of receiving therapy than participants with household incomes of $25,000 or lower.

The study did not cover the proportion of participants currently receiving HCV therapy, or therapy compliance.

Within the socioeconomic factors studied, participants who had not completed high school and participants with household incomes lower than $25,000 annually reported the highest rates of HCV investing, and the lowest rates of HCV testing.

Researchers pulled data from the Racial and Ethnic Approaches to Community Health Across the US Risk Factor Survey, which was conducted from May to November 2009 and December 2009 to August 2010. The survey was conducted in 28 minority communities located in 17 states, and included participants from non-Hispanic black, Hispanic, Asian, and American Indian and Alaskan Native groups.

The 2 surveys garnered 53,896 total participants. Of the participants, 40.2% identified as non-Hispanic blacks, 30.6% identified as Hispanic, 18.5% identified as Asian, and 10.7% identified as either American Indian or Alaskan Native. About 75.4% of patients reported having insurance coverage, and those identifying as Asian had the highest proportion of coverage (84.5%) compared with the other surveyed groups.

Among the total participants, 19.5% reported having an HCV test, although the testing within each group varied, as did the reasons for testing. Among the participants who were tested, 8.3% reported an HCV diagnosis. Of the ethnic and racial populations in the survey, 9.2% of non-Hispanic Blacks, 8.3% of Hispanics, 6.8% of Asians, and 6.4% of American Indians or Alaskan Natives received an HCV diagnosis.

Overall, among participants with HCV, 44.4% reported being followed by a physician for the virus specifically, and 41.9% reported having taken HCV medications at some point following their diagnosis. Compared with the other groups, participants in the Asian group were least likely to report physician attention for HCV (37.5%), whereas American Indian or Alaska Natives were least like to report having taken HCV medications following diagnosis (37.5%).

Although HCV risk factors occurred frequently in those tested for the virus, 40% of overall participants reported a risk factor but had not been tested for HCV. Among Asian participants, 60% of those reporting intravenous drug use had not been tested for HCV.

As a result, the authors noted that actual HCV infections rates could be higher than in their study, because certain high-risk participants had not been tested for the virus.

Additional study limitations included reliance on participant self-reporting, lack of clinical data on comorbidities that could preclude treatment, lack of data on participants who were diagnosed and cured of HCV infection, and the absence of a nonminority comparison group, they added.

Disparities in HCV prevalence have been previously observed between several racial groups, and research has also determined that minority communities, particularly those with lower socioeconomic status, tend to have more formidable health care barriers and greater disease risk and burden. Despite these findings, few studies focus on the socioeconomic factors relating to HCV testing and infection in racial and ethnic minority populations, the authors noted.

“Demographic and socioeconomic factors were significant determinants of HCV testing, infection, and linkage to care even after controlling for established risk factors of hepatitis C infection,” the authors noted. “HCV testing and prevention activities should be improved among people of minority race/ethnicity, particularly those of lower socioeconomic status, to reduce the racial/ethnic gaps in HCV infections and prevent significant increases in health care costs and increased mortality from end-stage liver disease.”