Increasing US Emergency Department Visits Associated With HCV

Emergency Department
Emergency Department
As emergency departments (EDs) are critical settings for hepatitis C care in the United States, investigators evaluated trends and characteristics of hepatitis C-associated ED visits from 2006 to 2014.

From 2006 to 2014, the number, rate, and cost of hepatitis C virus (HCV)-associated emergency department (ED) visits increased significantly, especially among baby boomers and Medicare and Medicaid beneficiaries, according to study results published in Public Health Reports.1

HCV infection affects approximately 2.4 million persons in the United States, and the ED is an important setting for HCV care.2-5 In order to develop effective guidelines and programs for ED-based HCV care, researchers assessed trends in numbers, rates, and costs of HCV-associated ED visits overall and in subgroups defined by demographic characteristics, liver disease severity, and patients dispositions (ie, discharge destination of patients after ED care) in the United States.1 Using data from the 2006 to 2014 Nationwide Emergency Department Sample, they found that the rate per 100,000 visits of first-listed and all-listed HCV-associated ED visits increased significantly from 10.1 to 25.4 (P <.001) and from 484.4 to 631.6 (P <.001), respectively. Approximately 70% of these visits were by baby boomers (born 1945 to 1965), 30% by Medicare beneficiaries, and 40% by Medicaid beneficiaries. Significant rate increases occurred in visits by baby boomers, individuals born after 1965, Medicare beneficiaries, and individuals hospitalized after ED visits. In addition, annual HCV-associated total ED costs increased by 400% (first-listed) and 192% (all-listed) during this time period.

“Using nationally representative data, we found significant increases in numbers, rates, and costs of hepatitis C–associated ED visits during 2006-2014, indicating a large and increasing burden of ED-based HCV care in the United States,” concluded the investigators.1

They added, “Efforts to improve primary prevention, early HCV detection, linkage to care, and curative treatment among these patients at primary care settings are warranted to reduce the burden of HCV on the ED system.”

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1. Yin S, Barker L, Teshale EH, Jiles RB. Rising trends in emergency department visits associated with hepatitis C virus infection in the United States, 2006-2014. Public Health Rep. 2019 Oct 2:33354919878437. 

2. Denniston MM, Jiles RB, Drobeniuc J, et al. Chronic hepatitis C virus infection in the United States, National Health and Nutrition Examination Survey 2003 to 2010. Ann Intern Med. 2014;160(5):293-300.

3. Edlin BR, Eckhardt BJ, Shu MA, Holmberg SD, Swan T. Toward a more accurate estimate of the prevalence of hepatitis C in the United States. Hepatology. 2015;62(5):1353-1363.

4. Holmberg SD, Spradling PR, Moorman AC, Denniston MM. Hepatitis C in the United States. N Engl J Med. 2013;368(20):1859-1861.

5. Hofmeister MG, Rosenthal EM, Barker LK, et al. Estimating prevalence of hepatitis C virus infection in the United States, 2013-2016. Hepatology. 2019;69(3):1020-1031.