title: National estimates of healthcare utilization by individuals with hepatitis C virus infection in the United States.
abstract: BACKGROUND
  Hepatitis C virus (HCV) infection is a major public health problem in the United States. Although prior studies have evaluated the HCV-related healthcare burden, these studies examined a single treatment setting and did not account for the growing "baby boomer" population (individuals born during 1945-1965).
  
  
  METHODS
  Data from the National Ambulatory Medical Care Survey, the National Hospital Ambulatory Medical Care Survey, and the Nationwide Inpatient Sample were analyzed. We sought to characterize healthcare utilization by individuals infected with HCV in the United States, examining adult (≥18 years) outpatient, emergency department (ED), and inpatient visits among individuals with HCV diagnosis for the period 2001-2010. Key subgroups included persons born before 1945 (older), between 1945 and 1965 (baby boomer), and after 1965 (younger).
  
  
  RESULTS
  Individuals with HCV infection were responsible for >2.3 million outpatient, 73 000 ED, and 475 000 inpatient visits annually. Persons in the baby boomer cohort accounted for 72.5%, 67.6%, and 70.7% of care episodes in these settings, respectively. Whereas the number of outpatient visits remained stable during the study period, inpatient admissions among HCV-infected baby boomers increased by >60%. Inpatient stays totaled 2.8 million days and cost >$15 billion annually. Nonwhites, uninsured individuals, and individuals receiving publicly funded health insurance were disproportionately affected in all healthcare settings.
  
  
  CONCLUSIONS
  Individuals with HCV infection are large users of outpatient, ED, and inpatient health services. Resource use is highest and increasing in the baby boomer generation. These observations illuminate the public health burden of HCV infection in the United States.
authors.affiliation: Department of Emergency Medicine.
authors.forename: James W
authors.initials: JW
authors.lastname: Galbraith
authors.affiliation: Department of Emergency Medicine.
authors.forename: John P
authors.initials: JP
authors.lastname: Donnelly
authors.affiliation: Department of Medicine, Division of Infectious Disease, University of Alabama at Birmingham.
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Franco
authors.affiliation: Department of Medicine, Division of Infectious Disease, University of Alabama at Birmingham.
authors.forename: Edgar T
authors.initials: ET
authors.lastname: Overton
authors.affiliation: Department of Emergency Medicine.
authors.forename: Joel B
authors.initials: JB
authors.lastname: Rodgers
authors.affiliation: Department of Emergency Medicine.
authors.forename: Henry E
authors.initials: HE
authors.lastname: Wang
mesh_terms: D000368:Aged; D004636:Emergency Service, Hospital; D005260:Female; D017048:Health Care Costs; D019538:Health Care Surveys; D016174:Hepacivirus; D006526:Hepatitis C / Q000453:epidemiology* / Q000266:history; D049674:History, 21st Century; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D062486:Public Health Surveillance; D014481:United States / Q000453:epidemiology
keywords: emergency department; healthcare utilization; hepatitis C; infectious disease; screening