Supplementary Material for: Delayed Diagnosis of Hepatitis C Infection–Results of a Nationwide U.S. Study

Background & Aims:
Universal hepatitis C virus (HCV) screening for the U.S. 1945-65 birth cohort was recommended in 2012 and effective direct-acting antivirals (DAA) for HCV became available in 2014. To examine their impact on the HCV care cascade, we investigated the proportion of and factors associated with delayed HCV diagnosis in a nationwide real-world cohort in the U.S.

Methods:
We retrospectively analyzed 69,989 adults with an HCV-related liver complication using the Merative™ Marketscan® Medicare Database (1/2007-12/2021). Delayed HCV diagnosis was defined as HCV diagnosis occurring within 2 years prior to or any time after occurrence of a liver complication (cirrhosis, hepatocellular carcinoma, or liver transplant).

Results:
The cohort mean age was 55.8 years, 65.9% were male, and the vast majority (60,628 or 86.6%) had delayed HCV diagnosis with 47.7% occurring within 6 months of the complication. The percentage of delayed HCV diagnosis decreased from 89.1% before 2015 to 75.1% in 2015-2021. In multivariable logistic regression analysis, higher Charlson Comorbidity Index (CCI) and complication diagnosis dates after 2015 were associated with lower odds of having a delayed diagnosis for HCV, while male sex, alcohol use, and mental health were associated with higher odds of having a delayed HCV diagnosis.

Conclusion:
Delayed HCV diagnosis occurred in almost 9 in 10 patients with chronic hepatitis C (CHC) and liver complications overall and in 3 out of 4 even after DAA availability during the 2015-2021 time period. Further efforts are needed to improve HCV screening and linkage to care.