Brian Chan, MD, MPH

New research suggests hepatitis C virus (HCV) screenings in community health center settings could be effective in improving rates in largely underserved communities.

A team, led by Brian Chan, MD, MPH, Division of General Internal Medicine and Geriatrics, Addiction Medicine Section, Oregon Health & Science University (OHSU), assessed HCV screening disparities in adults served by community health centers by ethnicity and language preference.

The Value of Community Health Centers

HCV is linked to high morbidity and mortality in the Latin community in the US as chronic liver disease is the leading cause of death within this patient population.

There is a need to implement HCV screening programs in community health center settings to better serve disproportionate percentages of Latinos. Current estimates show Latino have a 6.8 HCV-related deaths per 100,000 compared to 4.5 per 100,000 in non-Hispanic whites.

In the observational cohort, the investigators looked at data between 2013-2017 for adults born 1945-1965 in the Accelerating Data Value Across a National Community Health Center Network (ADVANCE) EHR dataset. The exposures included race and ethnicity and language preference, labeled as non-Hispanic white, Latino-English preferred, or Latino-Spanish preferred. Each participant must have had their first encounter in a community health center network during the observational period began in 2013, when the HCV screening policy was updated.

Patients were excluded with an existing HCV diagnosis.

The investigators sought a primary outcome of the relative hazard of HCV screening, which was estimated using multivariate Cox proportional hazards regression. The investigators also determined the prevalence of a new HCV diagnosis by identifying whether the participant had a new HCV diagnosis code following the observation start.

The investigators also adjusted the data for potential confounders, including age, sex, insurance status at visits during the study period, substance use disorder from encounters diagnosis ICD9/10 codes excluding tobacco and nicotine, type I or II diabetes diagnosis, and number of primary care visits during the study period.

Comparing the Three Groups

There were 182,002 patients who met the criteria, 60% of which were non-Hispanic whites, 29% of which were Latino-Spanish preferred, and 11% were Latino-English preferred.

Of this group, 9% were screened for HCV, while 2.4% were diagnosed with HCV.

Latino-English preferred patients had an overall lower rate of screening compared to both other groups (5.5% vs 9.4% vs 9.6%). Latino-English preferred speakers had lower hazards of HCV screening (adjusted hazard ratio [aHR], 0.56; 95% confidence interval [CI]. 0.44-0.72) compared to non-Hispanic whites, while Latino-Spanish preferred had similar hazards of HCV screening (aHR, 1.11; 95% CI, 0.88-1.41).

“We found that in a large CHC network, adult Latinos who preferred English had lower hazards of HCV screening compared to non-Hispanic whites, while Latinos who preferred Spanish had similar hazards of screening as non-Hispanic whites,” the authors wrote. “Overall prevalence of HCV screening was low. Further work on the role of language preference in HCV screening is needed to better equip primary care providers to provide this recommended preventive service in culturally relevant ways.”

References

Chan B, Ezekiel-Herrera D, Bailey SR, et al. Screening for hepatitis C among Community Health Center patients by ethnicity and Language Preference. AJPM Focus. 2023:100077. doi:10.1016/j.focus.2023.100077