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Race/ethnicity and insurance status disparities in access to direct acting antivirals for hepatitis C virus treatment

The American Journal of Gastroenterologyvolume 113pages13291338 (2018) | Download Citation




Despite availability of highly effective direct acting antivirals (DAA), barriers in access to these therapies limit our ability to achieve HCV eradication. We aim to evaluate overall rates and predictors of HCV treatment across four community-based health-care systems focusing on race/ethnicity and insurance-specific disparities.


We retrospectively evaluated all adults with chronic HCV at four health care systems from 1 January 2011 to 28 February 2017, which included a large proportion of ethnic minorities, two safety-net systems, and a broad payer mix across four states. Overall and stratified HCV treatment rates were calculated using Kaplan–Meier methods. Multivariate logistic regression models evaluated for predictors of receiving treatment.


Among 29,544 chronic HCV patients (60.5% male, 38.4% black, 8.8% Hispanic, 18.7% Medicaid, 25.9% Medicare, 22.5% private/commercial), overall annual treatment rates were stable from 2011 (0.5%) to 2013 (2.0%), but increased from 2014 (4.8%) to 2017 (16.9%) after availability of DAAs. While similar treatment rates were observed by sex, significantly lower odds of treatment were observed in Hispanics (OR 0.48, 95% CI 0.39–0.60, p < 0.001) compared to non-Hispanic whites and among those with Medicaid (OR 0.21, 95% CI 0.20–0.24, p < 0.001) compared to commercially insured patients.


Among our cohort of 29,544 chronic HCV patients, we observed significant improvements in HCV treatment rates after the availability of DAAs in 2014, but overall treatment rates remained <20% in 2017. The lowest rates of treatment were seen among Hispanics and those with Medicaid or indigent care insurance, which is concerning given these are particularly vulnerable populations.

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We thank Caitlin Vining from the Liver Institute of Virginia and Do Young Kim from Ochsner Health System for their help with data abstraction.

Author information


  1. Division of Gastroenterology and & Hepatology, Alameda Health System—Highland Hospital, Oakland, CA, USA

    • Robert J. Wong MD, MS
  2. Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, TX, USA

    • Mamta K. Jain MD, MPH
  3. Parkland Health and Hospital System, Dallas, TX, USA

    • Mamta K. Jain MD, MPH
    •  & Christopher Clark BS
  4. Multi-Organ Transplant Institute, Ochsner Health System, New Orleans, LA, USA

    • George Therapondos MD
  5. Liver Institute of Virginia, Bon Secours Health System, Richmond, VA, USA

    • Mitchell L. Shiffman MD
  6. Medical Technology and Practice Patterns Institute, Bethesda, MD, USA

    • Onkar Kshirsagar BS
    •  & Mae Thamer PhD


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Guarantor of the article

Robert J. Wong.

Specific author contributions: Study concept and design: R.J.W., M.T.; Acquisition of data: R.J.W., M.K.J., G.T., M.L.S., O.K., C.C., M.T.; Analysis and interpretation of data: R.J.W., M.K.J., G.T., M.L.S., O.K., C.C., M.T. Statistical analysis: O.K., M.T. Drafting of the manuscript: R.J.W., M.T. Critical revision of the manuscript for important intellectual content: R.J.W., M.K.J., G.T., M.L.S., O.K., C.C., M.T. Study supervision: R.J.W., M.T., R.J.W. and M.T. had full access to all the data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis.

Financial support: This study was funded by an investigator initiated research grant from Gilead Sciences. Gilead Sciences had no role in the study design, collection, analysis, or interpretation of the data. Robert Wong is supported by an AASLD Foundation Clinical and Translational Research Award in Liver Diseases.

Potential competing interests: R.J.W.: Advisory board, consultant, speaker’s bureau, and research grants—Gilead Sciences; M.K.J.: Research grants: Gilead, Merck, Janssen, GlaxoSmithKline/ViiV Healthcare; G.T.: None; M.L.S.: Research grants: Abbvie, Bristol Myers Squibb, Conatus, CymaBay, Exalenz, Galectin, Genfit, Gilead, Intercept, Immuron, Merck, NGMBio, Novartis, Shire; Advisor/consultant: Abbvie, Bristol Myers Squibb, Gilead, Merck, OptumRx; Speaker’s bureau: Abbvie, Bayer, Bristol Myers Squibb, Daiichi Sankyo, Gilead, Merck; O.K.: None; C.C.: None; M.T.: None

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Correspondence to Robert J. Wong MD, MS.

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