Journal article
Regional and Rural-Urban Differences in the Use of Direct-acting Antiviral Agents for Hepatitis C Virus The Veteran Birth Cohort
Medical care, Vol.57(4), pp.279-285
04/01/2019
DOI: 10.1097/MLR.0000000000001071
PMCID: PMC6436819
PMID: 30807449
Abstract
Background: Veterans with hepatitis C virus (HCV) infection may face geographic obstacles to obtaining treatment.
Objective: We studied the influence of region and rural versus urban residence on receipt of direct-acting antiretroviral (DAA) medications for HCV.
Subjects: Veterans receiving care within Veterans Affairs Healthcare System born between 1945 and 1965.
Research Design: This is a observational study using national electronic health record data.
Measures: Receipt of DAAs was defined as >= 1 filled prescription from January 1, 2014 to December 31, 2016. Region (South, Northeast, Midwest, andWest) and residence (urban, rural-micropolitan, small rural towns, and isolated rural towns) variables were created using residential zone improvement plan codes and rural-urban commuting area (RUCA) codes. Multivariable models were adjusted for age, race, sex, severity of liver disease, comorbidities, and prior treatment experience.
Results: Among 166,353 eligible patients 64,854 received, DAAs. Variation by rural-urban residence depended on region. In unadjusted analyses, receipt varied by rural-urban designations within Midwest, and West regions (P<0.05) but did not vary within the South (P=0.12). Southern rural small town had the lowest incidence of DAA receipt (40.1%), whereas the incidence was 52.9% in Midwestern isolated rural towns. In adjusted logistic analyses, compared with southern urban residents (the largest single group), southern rural small town residents had the lowest odds ratio, 0.85 (95% confidence interval, 0.75-0.93), and Midwestern residents from isolated and small rural towns had the highest odds (odds ratio, both 1.27) to receive treatment.
Conclusions: Substantial geographic variation exists in receipt of curative HCV treatment. Efforts are needed to provide more equitable access to DAAs.
Details
- Title: Subtitle
- Regional and Rural-Urban Differences in the Use of Direct-acting Antiviral Agents for Hepatitis C Virus The Veteran Birth Cohort
- Creators
- Basile Njei - Yale UniversityDenise Esserman - Yale UniversitySupriya Krishnan - VA Connecticut Healthcare SystemMichael Ohl - Roy J. and Lucille A. Carver College of MedicineJanet P. Tate - VA Connecticut Healthcare SystemRonald G. Hauser - Yale UniversityTamar Taddei - VA Connecticut Healthcare SystemJoseph Lim - Yale UniversityAmy C. Justice - VA Connecticut Healthcare System
- Resource Type
- Journal article
- Publication Details
- Medical care, Vol.57(4), pp.279-285
- Publisher
- Lippincott Williams & Wilkins
- DOI
- 10.1097/MLR.0000000000001071
- PMID
- 30807449
- PMCID
- PMC6436819
- ISSN
- 0025-7079
- eISSN
- 1537-1948
- Number of pages
- 7
- Grant note
- U24 AA020794; U01 AA027090; U10 AA013566 / NIH/NIAAA; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute on Alcohol Abuse & Alcoholism (NIAAA) UL1TR001863 / NIH/NCATS; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Center for Advancing Translational Sciences (NCATS) U01AA020790 / NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute on Alcohol Abuse & Alcoholism (NIAAA) UL1TR001863 / NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Center for Advancing Translational Sciences (NCATS) I01BX003341 / Veterans Affairs; US Department of Veterans Affairs OMAT 7436 / VA-ORH
- Language
- English
- Date published
- 04/01/2019
- Academic Unit
- Psychiatry; Internal Medicine
- Record Identifier
- 9984359931302771
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