Does Inequity Regarding the Burden of Viral Hepatitis C and Linkage to Care Still Exist? An Analysis of the All of Us Dataset

Introduction: Hepatitis C viral infection is a significant cause of liver-related morbidity and mortality, in the United States (US), costing over 10 billion dollars annually health care spending. More than 2.4 million people in the US are HCV RNA positive. The national prevalence is estimated to be 2.0% but is notably higher among the vulnerable baby boomer cohort and among Hispanic and non-Hispanic Black individuals. The advent of direct-acting antiviral (DAA) agents significantly reduced the previous treatment disparity experienced by African-Americans who did not respond to interferon and ribavirin. We aimed to query the National Institutes of Health (NIH) All of Us dataset to determine if treatment disparities still exist. Methods: The All of Us dataset version 6 includes electronic health records data from 258,188 participants and contains survey data collected from May 6, 2018 to January 1, 2022. We determined the prevalence of HCV infection in this cohort. We compared the demographic characteristics of those treated and not treated with DAA. We also measured the predictors of uptake of direct-acting antiviral (DAA) treatment and calculated the odds of therapy. Results: We identified 4,959 patients with chronic HCV, corresponding to a prevalence of 1.92%. Among individuals who declared their race, 54.2% were White, and 44.1% identified as Black. The prevalence of HCV was 1.55% among Whites, 3.19% among Blacks and 1.69% in Hispanics. The largest proportion of HCV patients receiving treatment were Black individuals at 38.9%, compared to Whites at 22.6%. This difference was confirmed by multivariable regression analyses [OR = 1.93, 95% CI (1.65-2.25)]. Neither income level nor marital status significantly predicted DAA uptake on multivariate analysis. Smoking history and alcohol exposure also did not distinguish between the two groups (Table 1). Conclusion: Our study confirms the continued higher prevalence of HCV infection among Blacks relative to Whites in this country. It is likely that the higher uptake of DAAs among African Americans is due to the accumulated treatment failures from the past. Current DAAs have nearly 99% efficacy, few side effects, and short treatment courses. Therefore, DAAs are being used more by those who would benefit the most. Table 1. - Demographics of chronic Hepatitis C Patients treated and not treated with DAA Baseline Characteristics No DAA Treatment (N= 3,532) DAA Treatment (N=1,427) P-value Female sex — no. (%) 1498 (42.4) 560 (39.2) 0.112 Age — yr (SD) 58.8 (12.4) 62.0 (10.6) < 0.001 Race — no. (%) < 0.001 White 1,636 (46.3) 477 (33.4) Black 1,049 (29.7) 669 (46.9) Asian 36 (1.0) < 20 Hispanic — no. (%) 634 (18.0) 184 (12.9) < 0.001 Income — no. (%) 0.004 < 25K 1917 (54.3) 803 (56.3) ≧25K- < 100K 571 (16.2) 253 (17.7) ≧100K 168 (4.8) 39 (2.7) Education — no. (%) 0.589 Never attended - Grade 11 743 (21.0) 282 (19.8) Grade Twelve - College One to Three 2150 (60.9) 875 (61.3) College Graduate or Advanced Degree 467 (13.2) 190 (13.3) Married — no. (%) 719 (20.4) 252 (17.7) 0.051 Smoking history — no. (%) 2639 (74.7) 1083 (75.9) 0.227 Alcohol exposure — no. (%) 3020 (85.5) 1206 (84.5) 0.273 Drug use — no. (%) 0.023 None 564 (16.0) 190 (13.3) Marijuana 573 (16.2) 210 (14.7) Other Drugs: Cocaine, Hallucinogens, Inhalant Use, Methamphetamine, Prescription Opioids, Prescription Stimulants, Sedatives 2134 (60.4) 904 (63.3) Charlson Comorbidity Score (SD) 5.6 (3.6) 7.3 (4.2) < 0.001