title: Late diagnosis of hepatitis C virus infection in the Chronic Hepatitis Cohort Study (CHeCS): Missed opportunities for intervention.
abstract: To determine the stage of liver disease at initial diagnosis of hepatitis C virus (HCV) infection, we analyzed data from the Chronic Hepatitis Cohort Study (CHeCS), a large U.S. observational study. We examined the temporal relationships of initial HCV infection diagnosis with cirrhosis-defined by liver biopsy or mean FIB-4 score >5.88-and time to onset of cirrhotic decompensation in electronic medical records. We determined time in the health system prior to HCV diagnosis and rates of hospitalization and death following HCV diagnosis. Of 14,717 patients with chronic HCV seen during 2006-2011, 6,166 (42%) had a definable time of initial HCV diagnosis. Of these, 1,056 (17%) patients met our definition for "late diagnosis" with either cirrhosis concurrent with initial HCV diagnosis (n = 550), a first diagnosis of hepatic decompensation before or within 12 months after initial HCV diagnosis (n = 506), or both (n = 314). Patients with late diagnosis had an average of 6 years in the health system before their HCV diagnosis. In a comparison with patients without late diagnosis, hospitalization (59% versus 35%) and death (33% versus 9%) were more frequent among patients with late diagnosis. Among all who died, mean (median) time from initial HCV diagnosis to death was 4.8 (4.2) years.
  
  
  CONCLUSIONS
  Many CHeCS patients had advanced liver disease concurrent with their initial HCV diagnosis despite many years of engagement with the healthcare system, and these patients had high rates of hospitalization and mortality.
authors.affiliation: Division of Viral Hepatitis, CDC, Atlanta, GA.
authors.forename: Anne C
authors.initials: AC
authors.lastname: Moorman
authors.forename: Jian
authors.initials: J
authors.lastname: Xing
authors.forename: Stephen
authors.initials: S
authors.lastname: Ko
authors.forename: Loralee B
authors.initials: LB
authors.lastname: Rupp
authors.forename: Fujie
authors.initials: F
authors.lastname: Xu
authors.forename: Stuart C
authors.initials: SC
authors.lastname: Gordon
authors.forename: Mei
authors.initials: M
authors.lastname: Lu
authors.forename: Philip R
authors.initials: PR
authors.lastname: Spradling
authors.forename: Eyasu H
authors.initials: EH
authors.lastname: Teshale
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Boscarino
authors.forename: Vinutha
authors.initials: V
authors.lastname: Vijayadeva
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schmidt
authors.forename: Scott D
authors.initials: SD
authors.lastname: Holmberg
mesh_terms: D015331:Cohort Studies; D057210:Delayed Diagnosis; D018450:Disease Progression; D005260:Female; D019698:Hepatitis C, Chronic / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged