BACKGROUND: The average annual rate of new reported hepatitis C virus (HCV) infections in Alaska during 2003–2012 was 133.8/100,000 persons. The Centers for Disease Control and Prevention estimates that 45-85% of HCV-infected persons are unware of their status. Approximately three-quarters of persons with acute HCV infection will remain chronically infected. Cirrhosis occurs in >20% of persons with chronic HCV infection. Persons with decompensated cirrhosis can develop liver-related complications (LRC) requiring hospitalization. Direct-acting antiviral agents (DAA) that cure >90% of HCV-infected persons and prevent complications are now available. We aim to estimate the burden of HCV-associated hospitalizations among Alaska adults before widespread DAA use.
METHODS: An Alaska statewide discharge dataset, created from the Indian Health Service Inpatient Data (tribally-operated hospitals) and the Alaska State Inpatient Database (non-federal community-based hospitals), was analyzed for residents aged >18 years during 2010-2012. Hospitalizations were defined as HCV-associated if an acute/chronic/undifferentiated HCV diagnostic code was listed among the discharge diagnoses. To evaluate HCV-associated hospitalizations for LRC, we developed two diagnostic code groups: 1) LRC-specific codes (LRC was the primary cause of hospitalization: variceal bleed, spontaneous bacterial peritonitis, hepatic encephalopathy), and 2) LRC-sensitive codes (LRC was a probable contributing cause of hospitalization: LRC-specific causes plus ascites, hepatorenal/hepatopulmonary syndrome, primary liver cancer, coagulopathy, cirrhosis). Average annual hospitalization rates/100,000 persons were calculated using corresponding annual population data.
RESULTS: Of the 102,057 hospitalizations (rate: 7,352.6/100,000) in Alaska during 2010–2012, 2,546 (2.5%; rate: 143.5/100,000) were HCV-associated hospitalizations. Most persons with HCV-associated hospitalizations had either undifferentiated (66.3%) or chronic (33.2%) HCV infection. The HCV-associated hospitalization rate was higher among males (148.3) than females (137.5), highest among persons aged 45–64 years (316.3) followed by persons aged >65 years (114.9) and 18–44 years (54.5). Among all hospitalizations, 830 (0.8%; rate: 45.6/100,000) were probably caused by HCV-associated LRC and 126 (0.1%; rate: 7.0/100,000) were primarily caused by HCV-associated LRC. The most common expected payment sources for HCV-associated hospitalizations were Medicare (25.0%) and Medicaid (23.7%).
CONCLUSIONS: The HCV-associated hospitalization rate was highest among persons aged 45–64 years. Our results could underestimate the HCV-associated hospitalization burden if a substantial proportion of hospitalized HCV-infected Alaskans were undiagnosed. One-time HCV testing for all inpatients born during 1945–1965, a CDC recommendation, could allow hospitals to identify and link to treatment previously undiagnosed persons with HCV infection. Expenditures for HCV-associated hospitalizations could decrease for healthcare payers, especially Medicare/Medicaid, if widespread DAA use reduced HCV prevalence.