Nationally representative study of more than 5 million pregnant people finds those with Medicaid less likely to be screened than those with commercial insurance, demonstrating disparities in prenatal care
, June 13, 2022 /PRNewswire/ -- A new Health Trends® study from Quest Diagnostics (NYSE: DGX) developed in collaboration with the Centers for Disease Control and Prevention (CDC) found that the rate of hepatitis C (HCV) antibody screening increased 145% in pregnant people during the decade-long study period ending June 2021, but is still low, with nearly 41% of pregnant people receiving screening in early 2021.The study, which was published in Obstetrics & Gynecology, is believed to be the first large scale, nationally representative analysis of the impact of medical guidelines on screening for HCV in pregnancy, based on deidentified test results of more than five million pregnant people across the United States.
In early 2020, the CDC and the US Preventative Services Task Force (USPSTF) published guidelines acknowledging the value of HCV antibody screening in adults, including pregnant people, in response to growing rates of HCV infection in the United States, particularly in younger adults and in pregnant people. While the study found a significant increase in screening among pregnant people after the publication of these guidelines, the results show many patients are not receiving the recommended testing.
"Our Health Trends study underscores the power of medical guidelines to favorably influence screening rates for diseases such as hepatitis C," said Harvey W. Kaufman, MD, Senior Medical Director, Head of the Health Trends Research Program for Quest Diagnostics. "Yet, it also reveals that gaps in guideline-based care are prevalent and highlights the urgent need to close them in underserved populations. We hope our research brings attention to quality gaps in maternal health in the United States and the importance of ensuring pregnant people are screened for HCV and other diseases that jeopardize their health and that of their newborns."
"For more than a decade, the opioid crisis has been associated with dramatic increases in hepatitis C among people of reproductive age in the United States, making screening among pregnant people critical to addressing this epidemic," said Carolyn Wester, MD, MPH, director of CDC's Division of Viral Hepatitis. "It's heartening to see an early increase in testing among pregnant people following our updated screening recommendations in 2020. However, we still have a long way to go given that less than half of mothers are receiving the recommended hepatitis C screening. And just as importantly, we must work to make sure those who are diagnosed are connected to postnatal treatment and cured of hepatitis C – otherwise, we are missing a critical opportunity to improve the health of mothers in this country."
2020 Ushers in New
Hepatitis C Screening Guidelines
In March 2020, the USPSTF recommended laboratory screening for HCV in adults aged 18–79 years, including in pregnant people.2 In April 2020, the CDC recommended HCV screening for adults aged 18 years and over, and for all pregnant people during each pregnancy except in settings where the prevalence of HCV infection is less than 0.1%.3 In May 2021, the American College of Obstetricians and Gynecologists (ACOG) issued, and the Society of Maternal-Fetal Medicine endorsed, a practice advisory recommending hepatitis C screening for all pregnant people during each pregnancy.4
After 2020 Guidelines, Rate of HCV Screening Significantly Increased
The study included 5,048,428 pregnant people ages 15-44 years in all 50 states and the District of Columbia with either Medicaid or commercial health insurance who had obstetric panel testing that included HCV antibody screening performed by Quest Diagnostics. The study examined testing patterns in this population between January 2011 and June 2021. Approximately three quarters (74.6%) had commercial health insurance and one in four (25.4%) were insured through Medicaid.
In the study period overall, 23.3% had an HCV screening test during their pregnancy. During the 10.5-year study period, the screening rate increased 145%, from 16.6% in 2011 to 40.6% in 2021. After the 2020 hepatitis C screening recommendations were published, the rate of HCV testing significantly increased relative to the pre-universal recommendation period.
Disparities in Testing Rates Associated with Insurance Type
For the entire study period, the percentage of individuals with HCV screening was higher for commercially insured persons (25%) than those with Medicaid (18.4%). However, the disparities seem to increase over time. Pregnant people with Medicaid had HCV screening rates comparable to people with commercial insurance in 2011-2012. From 2016 onward, people with Medicaid were tested for HCV infection at rates 25-35% lower than people with commercial insurance.
The study builds on an ongoing collaboration between Quest and CDC to study viral hepatitis prevalence and testing patterns, based on insights from laboratory testing, to support the goal to eliminate hepatitis in the United States. In 2017, Quest and CDC published research based on Health Trends laboratory data that found the rate of pregnant people and newborns with hepatitis C increased between 2011 and 2014.5 In 2021, researchers from both organizations published a study that revealed a 40% decline in HCV diagnosis and treatment during the early months of the COVID-19 pandemic.6
The study's strengths include national scale and results of quality laboratory testing methods. Weaknesses include lack of medication and other clinical data to identify patterns in treatment.
About Hepatitis C
Hepatitis C is the most common bloodborne infection in the United States and is a leading cause of liver-related morbidity and mortality.7,8 An estimated 2.4 million adults in the United States are living with HCV infection. Hepatitis C was reported as the underlying or contributing cause for 15,713 deaths in 2018.7 Approximately 70% of adults with acute HCV infection develop chronic disease. If untreated, 1 in 4 of these individuals will die prematurely from HCV-associated complications such as liver failure and hepatocellular carcinoma.8 During 2015–2018, 61% of people diagnosed with hepatitis C were aware they were living with the disease, suggesting a gap in care.9 The risk of an HCV-infected mother transmitting infection to their infant is approximately 4% to 7% per pregnancy.10 An estimated 1,700 infants were born with HCV infection each year between 2011 and 2014.11
About Quest Diagnostics Health Trends®
Quest Diagnostics Health Trends® is a series of scientific reports that provide insights into health topics, based on analysis of HIPAA-compliant, objective clinical laboratory data, to empower better patient care, population health management and public health policy. The reports are based on the Quest Diagnostics database of 60 billion de-identified laboratory test results, believed to be the largest of its kind in healthcare. Health Trends has yielded novel insights to aid the management of allergies and asthma, prescription drug monitoring, diabetes, Lyme disease, heart disease, influenza and workplace wellness. Quest Diagnostics also produces the Drug Testing Index (DTI)™, a series of reports on national workplace drug positivity trends based on the company's employer workplace drug testing data. http://www.QuestDiagnostics.com/HealthTrends
About Quest Diagnostics
Quest Diagnostics empowers people to take action to improve health outcomes. Derived from the world's largest database of clinical lab results, our diagnostic insights reveal new avenues to identify and treat disease, inspire healthy behaviors and improve healthcare management. Quest annually serves one in three adult Americans and half the physicians and hospitals in the United States, and our 50,000 employees understand that, in the right hands and with the right context, our diagnostic insights can inspire actions that transform lives. www.QuestDiagnostics.com
Munira Z. Gunja et al., Health and Health Care for Women of Reproductive Age: How the United States Compares with Other High-Income Countries (Commonwealth Fund, Apr. 2022). https://doi.org/10.26099/4pph-j894
U.S. Preventative Services Task Force. Hepatitis C virus infection in adolescents and adults: screening: United States Preventative Services Task Force statement. JAMA. 2020;323(10):970‒975. https://doi.org/10.1001/jama.2020.1123.
- Schillie S, Wester C, Osborne M, Wesolowski L, Ryerson AB. CDC Recommendations for Hepatitis C Screening Among Adults — United States, 2020. MMWR Recomm Rep 2020;69(No. RR-2):1–17. DOI: http://dx.doi.org/10.15585/mmwr.rr6902a1external icon.
ACOG Practice Advisory: Routine Hepatitis C Virus Screening in Pregnant Individuals (opqic.org)Schillie S, Wester C, Osborne M, Wesolowski L, Ryerson AB. CDC recommendations for hepatitis C screening among adults — United States, 2020. MMWR Recomm Rep. 2020;69(RR-2):1–17. https://doi.org/10.15585/mmwr.rr6902a1.
- Kaufman, H. Decreases in Hepatitis C Testing and Treatment During the COVID-19 Pandemic. American Journal of Preventive Medicine. September 1, 2021. https://doi.org/10.1016/j.amepre.2021.03.011
- Viral hepatitis surveillance—United States, 2018. Atlanta, GA: HHS, CDC; 2020. https://www.cdc.gov/hepatitis/statistics/2018surveillance/index.htm. Accessed March 30, 2021.
- Seo S, Silverberg MJ, Hurley LB, et al. Prevalence of spontaneous clearance of hepatitis C virus infection doubled from 1998 to 2017. J Clin Gastroenterol Hepatol. 2020;18(2):511‒513. https://doi.org/10.1016/j.cgh.2019.04.035.
Ryerson AB, Schillie S, Barker LK, Kupronis BA, Wester C. Vital signs: newly reported acute and chronic hepatitis C cases — United States, 2009–2018. MMWR Morb Mortal Wkly Rep. 2020;69(14):399‒404. https://doi.org/10.15585/mmwr.mm6914a2.
- Ly, K., et. al., Hepatitis C Virus Infection Among Reproductive-Aged Women and Children in the United States, 2006 to 2014. Annals of Internal Medicine. May 9, 2020. https://doi.org/10.7326/M16-2350
- Roberts EA, Yeung L. Maternal-infant transmission of hepatitis C virus infection. Hepatology. 2002;36(5 Suppl 1):S106-13.
- Ly, K. N., Jiles, R. B., Teshale, E. H., Foster, M. A., Pesano, R. L., & Holmberg, S. D. (2017). Hepatitis C virus infection among reproductive-aged women and children in the United States, 2006 to 2014. Annals of internal medicine, 166(11), 775-782.
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