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African-American patients had fewer office visits and were less likely to return for a second office visit
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"IMPACT OF PATIENT RACE AND GENDER ON THE CARE
OF A LARGE COHORT OF COMMUNITY BASED HEPATITIS
C PATIENTS "
Reported by Jules Levin
http://www.natap.org
from AASLD
Nov 11, 2005, San Francisco
Thomas M. Shehab, Huron Gastro, Ypsilanti, MI; Randall R. Randhawa, St. Joseph Mercy Hospital, Ypsilanti, MI; Anna M. Jankowski, Robert L. Stoler, Huron Gastro, Ypsilanti, MI
Introduction: Previous research has demonstrated that patient race and gender affect the management of a number of diseases. While race affects the efficacy of hepatitis C therapy, the impact of race and gender on the care of hepatitis C patients has not been assessed. The aim of this study is to determine if race and gende influence the provision of care (diagnostic evaluation/treatment) of a large cohort of patients seeking consultative care for hepatitis C in a community based, private practice gastroenterology group.
Methods: Retrospective chart review was performed for all patients referred for evaluation of hepatitis C between 1997 and 2002. The review assessed patient demographics, laboratory evaluation, disease severity and treatment response (Interferon/Ribavirin or Pegylated Interferon/Ribavirin).
Results:
670 patients were seen for an initial consultation for hepatitis C during the study period. 59% of patients were male, 80% were Caucasian (Cauc), 15% African-American (AA) and mean age was 45 years.
A statistically significant difference (p<0.05) was seen between Cauc and AA patients in the following categories: BMI, proportion of patients who returned for a second office visit, compliance with office visits, genotype and sustained virologic response (SVR) (Table 1).
The mean number of office visits during the study based on race/gender was: 5 for Cauc men and women, 4 for AA women and 2 for AA men.
There was no significant difference in indication for referral, rates of viremia, diagnostic evaluation, proportion of patients offered therapy or proportion of patients with elevated liver enzymes based on race or gender.
The patient’s gender did not affect the proportion of patients with advanced fibrosis, elevated liver enzymes or likelihood of receiving hepatitis C therapy.
Conclusion: Race had a significant impact on a number of factors that are important in the care of hepatitis C patients. In addition to lower rates of virologic response, African-American patients had fewer office visits and were less likely to return for a second office visit. The disparity was even more significant in African American men. Overall, gender had little impact on the evaluation,
histologic severity and initiation of treatment.
While much attention has been focused on the impact of race on treatment response, further research must clarify barriers that may negatively affect the care of certain subgroups of hepatitis C
patients.
* denotes p 0.05
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