Selected and summarized by Ronald O. Valdiserri, MD, MPH, Professor, Department of Epidemiology, Rollins School of Public Health, Emory University, and Co-Chair of HepVu.
Dr. Valdiserri reviews significant articles on prevention, public health, and policy advances in viral hepatitis. This month, he highlights “Temporal Trends in Hepatitis C—Related Hospitalizations, United States, 2000-2019.” Hofmeister MG, Zhong Y, Moorman AC, Samuel CR, Teshale EH, Spradling PR. Clinical Infectious Diseases 2023; 77(12): 1668-1675.
What question(s) does this study address?
Prior to the development of all oral, highly effective, direct acting agents (DAAs) to treat Hepatitis C in 2013, it was estimated that the virus was responsible for nearly 65,000 hospitalizations in the United States during 2010—2011, resulting in charges totaling some $3.5 billion. Although Hepatitis C is curable in over 95% of cases with current treatments, a recent analysis estimated that almost half (40%) of persons with HCV infection in the U.S. are unaware of their illness. Even among those who are diagnosed and have health insurance, only about 1 in 3 receive timely treatment.
Using data from the National Inpatient Sample (NIS)—the largest publicly available, all-payer inpatient care data base in the U.S—Hofmeister and her colleagues examined trends in HCV-related hospitalizations between 2000—2019, a twenty year timeframe encompassing the periods before and after the availability of DAAs that can cure Hepatitis C infection, thus preventing severe liver disease that requires hospitalization.
What are the major findings of this report/article?
- During the period of the study (2000-2019) there were an estimated 1,286,397 HCV-related hospitalizations in the United States.
- The annual age-adjusted hospitalization rate was highest in 2012 (29.6/100,000 population) and lowest in 2019 (18.7/100,000 population).
- Most HCV-related hospitalizations occurred among persons who were: aged 45-64 years (71.8%), male (67.1%), White, non-Hispanic (60.5%), living in urban areas (85.0%) and covered by Medicaid or Medicare (64.0%).
- The national age-adjusted HCV related hospitalization rate increased significantly during 2000-2013, before decreasing significantly during 2013-2019–after all oral DAA treatment for HCV became available.
- Comparing 2000 to 2019, the largest increases in age-adjusted HCV-related hospitalization rates occurred among persons aged 55-64 years (132.9%), Medicaid recipients (41.6%), and Black, non-Hispanic persons (22.3%).
What are the implications for the prevention and control of viral hepatitis?
- Overall, HCV-related hospitalization rates increased significantly during 2000-2013, prior to the availability of all oral DAA treatment for HCV and were seen to decline steadily after 2013–coinciding with the release of all-oral DAA treatment.
- Declines in HCV-related hospitalizations following the release of all oral DAA treatment were not observed equally among age, race/ethnicity, or insurance category groups, indicating disparities in access to treatment.
- Diagnosing HCV and providing curative DAA treatment can reduce the need for future hospitalizations for severe liver disease, thus reducing both personal and societal costs.
- Expanded access to both HCV diagnostic services and timely DAA treatment is needed to eliminate disparities in disease burden, reduce morbidity and mortality, and prevent further HCV transmission.
