Cross-Sectional Trends and Disparities in Hepatitis C Testing By Educational Attainment Among Individuals in the US

Introduction:

Hepatitis C virus (HCV) infection is the most common blood-borne disease in the US. Approximately 3.5 million individuals in the US are estimated to be living with HCV. Among HCV infected individuals, 75% of cases are estimated to be born between 1945 and 1965 (the birth cohort) and CDC and USPSTF published recommendations for one time HCV testing for persons in the birth cohort in 2012 and 2013, respectively.

Methods:

A sample of 124,817 respondents aged ≥18 years from the National Health Interview Survey (NHIS) from 2013 to 2016 was used to examine associations between HCV test prevalence and demographic/socio-economic factors. In addition, cross-sectional trends in testing patterns were investigated by education status. Weighted logistic regression was used to assess trends and associations.

Results:

Between 2013 and 2016, the average annual percentage of adults reporting ever being tested for HCV was 12.7% (95% CI 12.5- 12.9). Among the individuals in the birth cohort, the percentage reporting ever having been tested increased from 12.9% (95% CI 12.3- 13.6) in 2013 to 14.8% (95% CI 14.1 – 15.5) in 2016. Those with some college education were more likely to be tested [aOR=1.65 (95% CI 1.54 – 1.77] compared to the people who did not attend college. Compared to those with private health insurance, individuals with military health insurance were substantially more likely to be tested [aOR=2.26 (95% CI 1.98 – 2.57)] as well as those dual enrolled in Medicaid and Medicare or having only Medicaid insurance. [aOR=1.83 (95% CI 1.53-2.19) and aOR=1.47 (95% CI 1.32 – 1.64), respectively]. When stratified by educational status, differences in HCV testing rates varied substantially, in particular, by health insurance status. For the high education group, 27% of individuals receiving military insurance reported ever being tested and 24% of those dual enrolled in Medicare & Medicaid reported ever being tested relative to those with private insurance (14%) [aOR=2.03 (95% CI 1.75-2.35) and aOR=1.98 (95% CI 1.51-2.60), respectively]. Among the low education group, only 9% of those privately insured, and 11% dually enrolled in Medicare & Medicaid reported ever being tested. For the low education group, the relative difference between privately insured and those covered by military insurance (25%) were substantial compared to those with private insurance [aOR=3.07 (95% CI 2.32-4.05)].

Conclusions:

Based on NHIS data, HCV test prevalence for the birth cohort has significantly increased between 2013 and 2016 but the overall rates of testing are quite low given the current CDC and USPSTF recommendations. In addition, disparities in testing identify areas where interventions should be implemented to improve testing rates overall.