title: Race and Gender Differences in the Use of Direct Acting Antiviral Agents for Hepatitis C Virus.
abstract: Direct acting antiviral agents (DAA) are highly effective yet expensive. Disparities by race and/or gender often exist in the use of costly medical advances as they become available.
  
  
  
  We examined a cohort of hepatitis C virus (HCV) patients who received care at the Veterans Administration facilities nationwide. We evaluated the effect of race and gender on DAA receipt after adjusting for socioeconomic status, liver disease severity, comorbidity, and propensity for healthcare use. To determine if disparities had changed over time, we conducted a similar analysis of HCV patients who were seen in the previous standard of care treatment era.
  
  
  
  Of the 145 596 patients seen in the current DAA era, 17 791 (10.2%) received treatment during the first 16 months of DAA approval. Black patients had 21% lower odds of receiving DAA than whites (odds ratio [OR] = 0.79; 95% confidence interval [CI], .75, .84). Overall, women were as likely to receive treatment as men (OR = 0.99; 95% CI, .90-1.09). However, the odds of receiving DAAs were 29% lower for younger women compared with younger men (OR = 0.71, 95% CI, .54-.93). Similar to the DAA cohort, black patients had significantly lower odds of receiving treatment than whites (OR = 0.74, 95% CI, .69-.79) in the previous treatment era. The racial difference between the 2 eras did not reach statistical significance.
  
  
  
  There were unexplained differences among HCV population subgroups in the receipt of new DAA treatment. Targeted interventions are needed for black patients and younger women.
authors.affiliation: Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center Section of Gastroenterology and Hepatology Section of Health Services Research Department of Medicine, Baylor College of Medicine, Houston, Texas.
authors.forename: Fasiha
authors.initials: F
authors.lastname: Kanwal
authors.affiliation: Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center Section of Health Services Research.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Kramer
authors.affiliation: Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center Section of Gastroenterology and Hepatology Section of Health Services Research Department of Medicine, Baylor College of Medicine, Houston, Texas.
authors.forename: Hashem B
authors.initials: HB
authors.lastname: El-Serag
authors.affiliation: Center for Innovation to Implementation (Ci2i): Fostering High Value Care, VA Palo Alto Healthcare System, and Stanford, California.
authors.forename: Susan
authors.initials: S
authors.lastname: Frayne
authors.affiliation: Center for Healthcare Organization and Implementation, Edith Nourse Rogers Memorial Veterans Hospital, Boston, Massachusetts Department of Health Policy and Management, Boston University School of Public Health, Massachusetts.
authors.forename: Jack
authors.initials: J
authors.lastname: Clark
authors.affiliation: Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center.
authors.forename: Yumei
authors.initials: Y
authors.lastname: Cao
authors.affiliation: Center for Innovation to Implementation (Ci2i): Fostering High Value Care, VA Palo Alto Healthcare System, and Stanford, California.
authors.forename: Thomas
authors.initials: T
authors.lastname: Taylor
authors.affiliation: Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center.
authors.forename: Donna
authors.initials: D
authors.lastname: Smith
authors.affiliation: Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center Section of Health Services Research.
authors.forename: Donna
authors.initials: D
authors.lastname: White
authors.affiliation: Center for Innovation to Implementation (Ci2i): Fostering High Value Care, VA Palo Alto Healthcare System, and Stanford, California.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
mesh_terms: D001741:Black or African American; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D016174:Hepacivirus / Q000187:drug effects*; D006526:Hepatitis C / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D044465:White People
chemical_list: D000998:Antiviral Agents
keywords: Veterans; access; healthcare disparities; hepatitis; quality