Racial Differences in the Evaluation and Treatment of Hepatitis C Among Veterans: A Retrospective Cohort Study

We examined the association between race and hepatitis C virus (HCV) evaluation and treatment of veterans in the Northwest Network of the Department of Veterans Affairs (VA). In our retrospective cohort study, we used medical records to determine antiviral treatment of 4263 HCV-infected patients fro...

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Bibliographic Details
Published in:American journal of public health (1971) 2008-05, Vol.98 (5), p.846-852
Main Authors: Rousseau, Christine M, Ioannou, George N, Todd-Stenberg, Jeffrey A, Sloan, Kevin L, Larson, Meaghan F, Forsberg, Christopher W, Dominitz, Jason A
Format: Article
Language:English
Subjects:
Adult
African Americans
Antiviral Agents - therapeutic use
Bias
Biological and medical sciences
Biopsy
Black People
Cohort analysis
Cohort Studies
Consumer health information
Contraindications
Disease
Drug use
Epidemiology
Esophagus
General aspects
Genotype & phenotype
Health care
Hepatitis
Hepatitis C
Hepatitis C - diagnosis
Hepatitis C - drug therapy
HIV
Hospitals, Veterans
Human immunodeficiency virus
Human viral diseases
Humans
Infections
Infectious diseases
Interferon
Laboratories
Liver
Logistic Models
Male
Medical records
Medical Records Systems, Computerized
Medical sciences
Medical treatment
Middle Aged
Miscellaneous
Multicenter Studies as Topic
Patient education
Patients
Prejudice
Public health
Public health. Hygiene
Public health. Hygiene-occupational medicine
Race
Racial differences
Research and Practice
Retrospective Studies
Risk factors
Skin cancer
Sociodemographics
United States
United States Department of Veterans Affairs - statistics & numerical data
Veterans
Viral diseases
Viral hepatitis
White People
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Summary:We examined the association between race and hepatitis C virus (HCV) evaluation and treatment of veterans in the Northwest Network of the Department of Veterans Affairs (VA). In our retrospective cohort study, we used medical records to determine antiviral treatment of 4263 HCV-infected patients from 8 VA medical centers. Secondary outcomes included specialty referrals, laboratory evaluation, viral genotype testing, and liver biopsy. Multiple logistic regression was used to adjust for clinical (measured through laboratory results and International Classification of Diseases, Ninth Revision, codes) and sociodemographic factors. Blacks were less than half as likely as Whites to receive antiviral treatment (odds ratio [OR]=0.38; 95% confidence interval [CI]=0.23, 0.63). Both had similar odds of referral and liver biopsy. However, Blacks were significantly less likely to have complete laboratory evaluation (OR=0.67; 95% CI=0.52, 0.88) and viral genotype testing (OR=0.68; 95% CI=0.51, 0.90). Race is associated with receipt of medical care for various medical conditions. Further investigation is warranted to help understand whether patient preference or provider bias may explain why HCV-infected Blacks were less likely to receive medical care than Whites.
ISSN:0090-0036
1541-0048
1541-0048
DOI:10.2105/AJPH.2007.113225