摘要：Objectives. We estimated rates and determinants of hepatitis C virus (HCV) testing, infection, and linkage to care among US racial/ethnic minorities. Methods. We analyzed the Racial and Ethnic Approaches to Community Health Across the US Risk Factor Survey conducted in 2009–2010 (n = 53 896 minority adults). Results. Overall, 19% of respondents were tested for HCV. Only 60% of those reporting a risk factor were tested, with much lower rates among Asians reporting injection drug use (40%). Odds of HCV testing decreased with age and increased with higher education. Of those tested, 8.3% reported HCV infection. Respondents with income of $75 000 or more were less likely to report HCV infection than those with income less than $25 000. College-educated non-Hispanic Blacks and Asians had lower odds of HCV infection than those who did not finish high school. Of those infected, 44.4% were currently being followed by a physician, and 41.9% had taken HCV medications. Conclusions. HCV testing and linkage to care among racial/ethnic minorities are suboptimal, particularly among those reporting HCV risk factors. Socioeconomic factors were significant determinants of HCV testing, infection, and access to care. Future HCV testing and prevention activities should be directed toward racial/ethnic minorities, particularly those of low socioeconomic status. Hepatitis C virus (HCV) infection affects almost 3 million Americans and is the leading cause of death associated with liver disease in the United States. 1,2 Racial disparities in the prevalence of HCV infection have previously been documented: Non-Hispanic Blacks have the highest prevalence of HCV infection in the United States, about twice that reported among non-Hispanic Whites. 1 Fewer data exist on the prevalence of hepatitis C among the Latino population, and they have been derived mainly from the National Health and Nutrition Examination Survey, in which only Mexican Americans were represented. 1,3,4 Even more limited data are available on the prevalence of HCV infection among Asians and American Indians/Alaska Natives (AI/ANs), with most of the studies localized to specific states or facilities. 5–8 More important is the dearth of data regarding the prevalence of hepatitis C testing and access to care—information critical to public health planning and policy—among racial/ethnic minorities in the United States. Early identification and treatment of hepatitis C infection are essential to prevent liver cancer and associated health care costs. 9,10 Over the 10-year period from 2010 to 2019, the direct medical cost of chronic HCV infection is projected to exceed $10.7 billion, and the societal cost of premature mortality is estimated at $54.2 billion. 11 Studies have reported that several minority communities have disproportionately lower socioeconomic status, greater barriers to access to health care, and greater risks for and burden of disease compared with Whites or the general population living in the same geographical area. 12–14 Socioeconomic factors have been postulated to play a role in access to care and treatment of hepatitis C. 15–17 However, very few studies have assessed the role played by socioeconomic factors in hepatitis C testing and infection among racial/ethnic minorities. Not all racial/ethnic minorities were included in these studies, and the majority failed to control for traditional HCV infection risk factors. 1,4,18 The Centers for Disease Control and Prevention’s recommendations for HCV testing are based on presence of HCV risk factors, hence the need to control for them while assessing the determinants of hepatitis C testing and infection. 19 In 2006, 1 of every 4 US residents identified themselves as being a racial/ethnic minority, 20 and the US Census Bureau has projected that by 2050 minority populations will make up approximately 50% of the US population. 21 Thus, a need exists for more information about hepatitis C among the different racial/ethnic groups in the United States to be able to design evidence-based prevention interventions and avoid the projected increases in medical expenses. 11 The objectives of this study were to assess hepatitis C testing, infection, and access to health care and treatment among racial/ethnic minorities in the United States and to examine whether demographic, socioeconomic, and hepatitis C risk factors influence hepatitis C testing, infection, and access to care in this population.
