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Goodman S, Zahn M, Bruckner T, Boden-Albala B, Lakon CM. Measuring Hazards of Undetectable Viral Load among Hepatitis C Antibody Positive Residents of a Large Southern California County. Health Serv Res Manag Epidemiol 2021; 8:23333928211066181. [PMID: 34926722 PMCID: PMC8671667 DOI: 10.1177/23333928211066181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 12/09/2022] Open
Abstract
Background Hepatitis C virus (HCV) infection is the most common bloodborne infection in the U.S. However, only a small proportion of persons are treated and cured. Previous research has not characterized sociodemographic characteristics of who receives treatment. We examined predictors of undetectable for HCV in Orange County, the sixth largest county in the United States, where HCV is the most commonly reported infection. METHODS From 2014 to 2020, we acquired public health surveillance data from 91,165 HCV antibody-positive care encounters from the California Reportable Disease Information Exchange (CalREDIE). We used a time-to-event proportional hazards framework to estimate individual and area-level correlates of time-to-HCV undetectable viral load among HCV + individuals. RESULTS Older adults (>65 years) showed an increased hazard of undetectable viral load relative to younger adults (HR = 2.00). In addition, residents of census tracts with greater enrollment in health insurance showed a greater likelihood of undetectable viral load (HR = 1.36). The moderating effect of higher tract median household income and higher tract levels of health insurance were more likely to have undetectable viral load and was statistically significant. CONCLUSION In a large urban county, HCV antibody-positive older adults appear much more likely to show undetectable viral load compared to younger adults. Residents in areas with higher quartiles of health insurance enrollment have an increased likelihood of undetectable viral load. The extent to which constraints impede HCV care requires further investigation, including follow-up studies on health insurance type to test the relationship of health insurance type to undetectable viral load.
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Affiliation(s)
- Sara Goodman
- Program in Public Health, Department of Health, Society, and Behavior, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, Irvine, USA
| | - Matthew Zahn
- Communicable Disease Control, Orange County Health Care Agency, Santa Ana, California, USA
| | - Tim Bruckner
- Program in Public Health, Department of Health, Society, and Behavior, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, Irvine, USA
- Center for Population, Inequality, and Policy, University of California, Irvine, Irvine, USA
| | - Bernadette Boden-Albala
- Program in Public Health, Department of Health, Society, and Behavior, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, Irvine, USA
- School of Medicine, Department of Neurology, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, Irvine, USA
- Program in Public Health, Department of Epidemiology and Biostatistics, University of California, Irvine, Irvine, USA
| | - Cynthia M. Lakon
- Program in Public Health, Department of Health, Society, and Behavior, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, Irvine, USA
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