Hepatitis C Virus Screening Trends: Serial Cross-Sectional Analysis of the National Health Interview Survey Population, 2013–2015

Abstract

Rates of hepatitis C virus (HCV) infection are markedly higher for baby boomers compared with other birth cohorts, and they are now recommended for universal one-time screening. This study examines HCV screening rates and predictors for four birth cohorts [born <1945, born 1945-1965 (baby boomers), born 1966-1985, and born >1985] of a nationally representative sample over time. We used data from the 2013-2015 National Health Interview Surveys, an annual weighted survey of the U.S. civilian noninstitutionalized population. We assessed HCV screening prevalence stratified birth cohort with bivariate and multivariable logistic regression analyses. There were 15,100 participants born <1945, 28,725 baby boomers, 28,089 born 1966-1985, and 13,296 born >1985 in the final analytic sample. Screening was 11.5%-12.8% for baby boomers. The second youngest birth cohort was similar to baby boomers (13.7%-14.9%), whereas the older birth cohort was screened less. After excluding participants who typically have higher rates of HCV screening than the general population, we developed a multivariable model of the general population. In the final model for baby boomers the odds of HCV screening increased significantly with each subsequent year (OR=1.20; 95% CI=1.05-1.38 and OR=1.31; 95% CI=1.13-1.52). HCV screening was also significantly associated with age, gender, and race/ethnicity in baby boomers. While HCV screening is increasing over time, these increases are minimal and there is substantial room for improvement. Future research should develop interventions to increase HCV screening with special focus on groups demonstrating significantly lower screening rates, such as Hispanics and females. .

A blueprint for the primary prevention of cancer: Targeting established, modifiable risk factors

“…Unlike HBV, there is no vaccine for HCV. Thus, the US CDC recommends all individuals in the Baby Boomer birth cohort should be screened for HCV, although only 12.8% of adults in this birth cohort have been screened . Most of the new cases of HCV are occurring in young, white injection drugs users living in rural areas.…”

“…Thus, the US CDC recommends all individuals in the Baby Boomer birth cohort should be screened for HCV, although only 12.8% of adults in this birth cohort have been screened. 160 Most of the new cases of HCV are occurring in young, white injection drugs users living in rural areas. Notably, HCV causes approximately 24.2% of liver cancers in the United States, and the incidence rate of hepatocellular carcinoma has tripled over the last decade, 157 in part because of an increased prevalence of chronic HCV infection.…”

Electronic medical record‐verified hepatitis C virus screening in a large health system

“…However, our estimates are similar to national data that reported ~12% of baby boomers had been screened by the end of 2015. 10 Therefore, our results were unlikely to have been significantly affected by this limitation. Additionally, because this is a retrospective review of EMR data, our results are limited by physician recording and proper EMR documentation.…”

“…Patients in our study had similar percentages of HCV screening ordered as compared to self-reported national data reporting rates of HCV screening. 10 In both the EMR-verified and the self-reported national data, HCV screening was well below the CDC and USPSTF screening guidelines for universal screening of baby boomers. 7,9 Healthy People 2020 has a goal of increasing the number of people who are aware of their HCV infection from 53% to 60% 15 ; this is unlikely to happen without additional intervention.…”

“…As in national samples, men had a higher proportion of having screening ordered than women. 10 This could be for several reasons. One possibility is that physicians continue to screen their patients based on perceived risk, as opposed to universally screening all baby boomers.…”