Late presenters among minority patients with chronic hepatitis C infection in the USA
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ORIGINAL ARTICLE
Late presenters among minority patients with chronic hepatitis C infection in the USA Calvin Q. Pan1,2 Dan Wang5
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Charles Rabinovich3 • Vijay Gayam4 • Milana Normatov3 • Bazhena Fidman3
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Received: 30 June 2019 / Revised: 19 August 2020 / Accepted: 19 August 2020 / Published online: 29 August 2020 Ó Swiss School of Public Health (SSPH+) 2020
Abstract Objectives Minority patients are under-screened for chronic hepatitis C (CHC) in the USA, and limited data exist for minority patients with advanced fibrosis. Methods In this cross-sectional study, CHC patients who were prescribed direct-acting antiviral agents were divided into White patients and minority patient groups. Primary measurements were the mean fibrosis scores and percentages of patients with stage III–IV fibrosis (late presenters) for the two groups. Results Among the 1421 patients with self-reported ethnicity, 697 were White patients, and 724 were minority patients (484 Hispanic, 175 Black, 65 Asians). Compared to the White, minority patients had significantly higher mean fibrosis score (p \ 0.001) and a higher percentage of late presenters (p \ 0.001). In subgroup analyses, the mean fibrosis scores for Hispanic, Black and Asian patients were 2.58 ± 1.38, 2.28 ± 1.41 and 2.28 ± 1.40, respectively. Conclusions Minority populations with CHC in the USA experience disparities in access to treatment in the early stages of liver fibrosis. Public health strategies are necessitated to address the inequality, as late presenters are at risk of hepatocellular carcinoma. Keywords Chronic hepatitis C Late presenters Liver fibrosis Minority health disparity Direct-acting antiviral agents Treatment access Abbreviations CHC Chronic hepatitis C HCV Hepatitis C virus DAAs Direct-acting antivirals DM Diabetes HTN Hypertension CKD Chronic kidney disease
GT HCC APRI
& Calvin Q. Pan [email protected]
Globally, an estimated 71 million people have chronic hepatitis C infection (CHC), and approximately 399, 000 people die each year from hepatitis C-related cirrhosis and hepatocellular carcinoma (WHO Hepatitis C Update 2017). Treatment of CHC with the direct-acting antivirals (DAA’s) in patients with minimal or no hepatic fibrosis provides not only a significant reduction in the incidence of decompensation and hepatocellular cancer (HCC) but also high cure rates. In addition to disease-specific outcomes, patient-reported outcomes, including the quality of life and work productivity, are also improved (Younossi et al. 2018; WHO Combating hepatitis B and C to reach elimination by 2030 2016). By 2030, the target of the World Health
1
Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, No. 8, Jingshun East Street, Chaoyang District, Beijing 100015, China
2
Division of Gastroenterology and Hepatology, NYU Langone Health, New York University School of Medicine, 132-21 Forty-First Ave, Flushing, NY 11355, USA
3
Quality Specialty Pharmacy, 1611 University Ave, Bronx, NY, USA
4
Interfaith Medical Center, SUNY Downstate Unive
