Racial and Sociodemographic Disparities in Hepatitis C Treatment at an Urban Academic Medical Center, 2018-2023.

Background: Hepatitis C virus (HCV) disproportionately affects racial minorities and socially disadvantaged groups in the United States. Despite highly effective direct-acting antiviral (DAA) therapies, treatment disparities persist. Methods: We conducted a retrospective cohort study using electronic medical record data from both inpatient and outpatient settings in an urban academic medical center between 1 October 2018 and 1 October 2023. Multivariable logistic regression identified sociodemographic and clinical predictors of HCV treatment initiation, defined as a documented direct-acting antiviral prescription, among individuals with positive HCV RNA between 2018 and 2023. Results: Among 4345 individuals, 1150 (26.5%) were prescribed HCV treatment. Black individuals were less likely to be prescribed HCV treatment compared to White individuals (adjusted odds ratio [aOR], 0.68 [95% confidence interval {CI}, .53-.88]). Individuals experiencing homelessness (aOR, 0.57 [95% CI, .46-.69]) and those with Medicaid (aOR, 0.82 [95% CI, .68-.98]) or no insurance (aOR, 0.49 [95% CI, .37-.65]) were also less likely to be prescribed HCV treatment. Individuals with mental health diagnoses (aOR, 1.34 [95% CI, 1.11-1.61]) were more likely to receive HCV treatment. Untreated individuals had a higher percentage of inpatient (12.3%) and emergency department visits (17.7%) than those who received treatment (3.4% and 4.8%, respectively). Conclusions: Significant disparities in HCV treatment initiation were observed, with lower rates among Black individuals, those experiencing homelessness, and individuals with Medicaid or no insurance. These inequities perpetuate a disproportionate burden of liver disease and preventable mortality in already marginalized populations.