MedPage Today: Why and Where People Sought Testing For Hepatitis C

Risk Seldom the Reason for HCV Testing

Michael Smith , North American Correspondent
MedPage Today

Reviewed by Robert Jasmer, MD;
Associate Clinical Professor of Medicine, University of California, San Francisco

Nearly half of people with chronic hepatitis C (HCV) said they were only tested after they had some clinical sign or symptom, a CDC survey showed.

And only about one in five said they were tested because they fit one of the risk categories, such as injection drug use, defined by the CDC , the agency reported in the Aug. 16 issue of Morbidity and Mortality Weekly Report.

The findings come from a survey of nearly 4,700 people with chronic HCV under care in one of four U.S. integrated health-care systems -- the Geisinger Health System of Danville, Pa., the Henry Ford Health System of Detroit, Kaiser Permanente Hawaii of Honolulu, and Northwest Permanente of Portland, Ore.

Chronic HCV accounts for substantial morbidity and mortality in the U.S., the CDC report noted, adding that testing and treating people without symptoms might help reduce the impact.

The agency, recently joined by the U.S. Preventive Services Task Force, has urged a one-time HCV test for everyone born from 1945 to 1965, because research suggests they account for about 75% of infections.

To understand where and why people with current chronic HCV sought initial testing, the agency queried some 8,101 patients in the four health systems, of whom 4,689 (or 57.9%) completed the survey.

Of those, 78.1% were born from 1945 through 1965, 87.4% had a high school diploma or its equivalent, 98.1% had insurance, and 45.5% had jobs, while 23.2% were getting disability payments.

A doctor's office was the most common location for the initial test, reported by 60.4% of respondents, although the rate was slightly higher for those born during 1945 through 1965 at 62.1% and lower (at 54.3%) for those born outside that period.

The participants reported 7,649 reasons for their initial test (respondents could give multiple reasons), including 3,473 "miscellaneous" responses (or 45.4%) that were not part of the CDC's risk indications, including such things as having many sex partners, coming from a country with endemic HCV, or following a doctor's recommendation.

But almost half of the respondents -- some 2,121 -- said they were tested in response to a clinical sign, either an abnormal liver test or liver symptoms such as jaundice.

And 1,045 said they were tested because they fit into a CDC risk category -- 986 of them cited injection drug use and 59 cited hemodialysis.

Another 781 cited some institutional requirement, such as insurance, as a reason for testing.

The CDC report cautioned that the patients in the survey were not nationally representative, so the results can't be applied to the general U.S. population. Among other things, almost all had some form of health insurance.

Also, because only 57.9% of the eligible participants answered the survey, response bias might have arisen and the gap between initial testing and time of interview might have led to recall bias.

The analysis was supported by the CDC. Ko is an employee of the agency

Primary source: Morbidity and Mortality Weekly Report
Source reference: Centers for Disease Control and Prevention "Locations and reasons for initial testing for hepatitis C infection -- chronic hepatitis cohort study, United States, 2006-2010" MMWR 2013; 62: 645-648.