Theme: Epidemiology & Public Health Research Year: 2017
Recent surveillance data depicts an increased incidence of acute HCV in young injection drug users, most who escalate from oral opiates; and 45% of persons in the Birth Cohort(BC), reported no risk factors(RFs). EHR Screening is challenging as RFs are often entered as unstructured data, often not at all. Thus RF-based testing alone would miss many HCV-infected individuals outside of the BC.
Non-BC HCV testing data was collected from MedStar Health and a 1:3 case-control retrospective nested chart review was conducted. HCV RFs, opiate prescriptions and other variables were manually abstracted from the EHR and Explorys. Logistic regression models were utilized to determine HCV-Ab+ predictors.
From 7/1/15 – 6/30/16, 329 charts from 4,741 HCV tested non-BC patients were reviewed; 80 (1.7%) HCV Ab+ patients were compared to 249 randomly selected HCV-Ab- controls. Patients with >= one documented HCV RF were more likely to have Medicaid (p = 0.005) and Medicare (p = 0.003). Eighteen (23%) HCV-Ab+ and 123 (49%) HCV-Ab- had no identified RFs; 6 (33%) HCV-Ab+ reported RFs only after a positive test result. In multivariate logistic regression, persons were more likely HCV-Ab+: with reported drug use (ORadj26, CI956.1-109.8), had Medicaid v. private insurance (3.4, 1.6-7.7), and were white (3.4, 1.5-7.9), adjusting for demographic factors and opiate prescriptions (ROC = 0.823). There was a significant interaction between age >40 and opiate prescriptions and were 11x more likely to be HCV-Ab+ (CI95 1.6-74.8).
Drug use remains a significant predictor of HCV positivity outside the BC, though white race was more significant than black race. The CDC has reported an increase of HCV in injection opiate users’; our data shows an interaction for oral opiate use, often a precursor. Given patient and provider barriers in elucidating RFs, universal testing and those on chronic opiates may be warranted.