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Open Access Publications from the University of California

Scholarly Works (2 results)

  • Thesis
  • Peer Reviewed
UC Irvine Electronic Theses and Dissertations (2022)

Hepatitis C is the most infectious bloodborne disease in the United States. For my dissertation, I will focus on the study population in Orange County, California. This high-risk area has a significant substance use rehabilitation tourism industry with over 400 rehabilitation facilities).1 and a marked increase in reported HCV cases since 2011. 2 The purpose of this dissertation was to understand why, despite effective HCV treatment, Orange County patients who test antibody-positive are not directly followed up with viral load tests and then initiated on HCV treatment. This question merits further research using routinely collected and reported public health surveillance data and electronic medical records at health care facilities.

The goals of this research were to examine socioeconomic individual and group-level correlates of the following outcomes: HCV viral load testing, undetectable HCV viral load, and HCV diagnosis in a health care setting using the University of California, Irvine Medical Center (UCIMC) medical records with chart review. This research utilized secondary data using multivariable logistic regressions and multivariable Cox Proportional Hazard regression to answer these research questions.

With an n of 27,389 individuals, that only 3.16 percent of all patients from 2010 to 2020 showed undetectable viral load. Only 37 percent of these patients were not ever viral load tested from 2010 to 2020, leaving the viremic status of these patients unknown. Those over 65 were more likely to have an undetectable HCV viral load than younger adults (HR =2.00). Residents living in census tracts in the third and fourth quartiles of percent enrollment in health insurance showed a greater likelihood of undetectable viral load. When examining 521 electronic medical records (EMRs), only 22 percent of those reported as HCV antibody-positive indicated an HCV-positive diagnosis in their EMR. Less than one percent of patients n=5 were prescribed HCV treatment. These results show an alarming loss of follow-up and an inability to link patients to care with an opportunity to improve outcomes. The findings of this study are essential for informing future HCV policies and diagnosis procedures to get individuals tested and treated for this disease.

    Cover page: Using public health surveillance and electronic medical record data to examine socioeconomic factors for hepatitis C diagnosis and testing in Orange County, California
    • Article
    • Peer Reviewed
    UC Irvine Previously Published Works (2023)

    Background

    In California, laboratories report all hepatitis C (HCV)-positive antibody tests to the state; however, that does not accurately reflect active infection among those patients without a viral load test confirming a patient's HCV diagnosis. These public health surveillance disease incident records do not include patient details such as comorbidities or insurance status found in electronic medical records (EMRs).

    Objective

    This research seeks to understand how insurance type, insurance status, patient comorbidities, and other sociodemographic factors related to HCV diagnosis as defined by a positive viral load test among HCV antibody-positive persons from January 1, 2010 to March 1, 2020.

    Methods

    HCV antibody-positive individuals reported to the California Reportable Disease Information Exchange (CalREDIE), with a medical record number associated with the University of California, Irvine Medical Center, and an unrestricted EMR (n = 521) were extracted using manual chart review.

    Main outcomes and measures

    HCV diagnosis as indicated in a patient's EMR in the problem list or disease registry.

    Results

    Less than a quarter of patients in this sample were diagnosed as having HCV in their EMR, with 0.4% of those diagnosed (5/116) patients with indicated HCV treatment in the medication field of their charts. After adjusting for multiple comorbidities, a multinomial logistic regression found that the relative risk ratios (RRRs) of HCV diagnosis found that patients with insurance were more likely to be diagnosed compared to those without insurance. When comparing uninsured patients to those with government insurance at the P < .05 level (RRR = 10.61 (95% confidence interval (CI): 4.14-27.22)) and those uninsured to private insurance (RRR = 6.79 (95% CI: 2.31-19.92).

    Conclusions

    These low frequencies of HCV diagnosis among the study population, particularly among the uninsured, indicate a need for increased viral load testing and linkage to care. Reflex testing on existing samples and improving HCV screening and diagnosis can help increase linkage to care and work towards eliminating this disease.
      Cover page: Insurance Status, Comorbidity Diagnosis, and Hepatitis C Diagnosis Among Antibody-Positive Patients: A Retrospective Cohort Study
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