Racial differences in the evaluation and treatment of hepatitis C among veterans: a retrospective cohort study.
OBJECTIVE
We examined the association between race and hepatitis C virus (HCV) evaluation and treatment of veterans in the Northwest Network of the Department of Veterans Affairs (VA).


METHODS
In our retrospective cohort study, we used medical records to determine antiviral treatment of 4263 HCV-infected patients from 8 VA medical centers. Secondary outcomes included specialty referrals, laboratory evaluation, viral genotype testing, and liver biopsy. Multiple logistic regression was used to adjust for clinical (measured through laboratory results and International Classification of Diseases, Ninth Revision, codes) and sociodemographic factors.


RESULTS
Blacks were less than half as likely as Whites to receive antiviral treatment (odds ratio [OR]=0.38; 95% confidence interval [CI]=0.23, 0.63). Both had similar odds of referral and liver biopsy. However, Blacks were significantly less likely to have complete laboratory evaluation (OR=0.67; 95% CI=0.52, 0.88) and viral genotype testing (OR=0.68; 95% CI=0.51, 0.90).


CONCLUSIONS
Race is associated with receipt of medical care for various medical conditions. Further investigation is warranted to help understand whether patient preference or provider bias may explain why HCV-infected Blacks were less likely to receive medical care than Whites.
Rousseau
Christine M
CM
Northwest Health Services Research and Development Center of Excellence and the Northwest Hepatitis C Resource Center, VA Puget Sound Health Care System, Seattle, WA, USA. cmr@u.washington.edu
Ioannou
George N
GN
Todd-Stenberg
Jeffrey A
JA
Sloan
Kevin L
KL
Larson
Meaghan F
MF
Forsberg
Christopher W
CW
Dominitz
Jason A
JA
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D044383:Black People; D015331:Cohort Studies; D006526:Hepatitis C / Q000175:diagnosis / Q000188:drug therapy*; D006787:Hospitals, Veterans; D006801:Humans; D016015:Logistic Models; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011287:Prejudice; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*; D014728:Veterans; D044465:White People; D001741:Black or African American
D000998:Antiviral Agents