Diagnosis and 10-year follow-up of a community-based hepatitis C cohort

OBJECTIVE: To determine the health care follow-up and treatment associated with physician-diagnosed hepatitis C (HCV) in a community-based population. STUDY DESIGN: We conducted a retrospective medical record review using records from all providers in Olmsted County, Minnesota. POPULATION: The study incorporated all Olmsted County residents with physician-diagnosed hepatitis C from 1990 through 1999. OUTCOMES MEASURED: We assessed demographic and health status information as well as health services use in subjects with physician-diagnosed HCV. RESULTS: Physicians diagnosed hepatitis C in 355 subjects (219 men [62%], 136 women [38%]), mean age 43 years, in the 10-year period studied. About half of diagnoses (45%, n = 159) were confirmed with polymerase chain reaction or liver biopsies. Identified risk factors included IV drug use (50%), multiple sex partners (36%), and blood transfusion (30%). Follow-up assessment with aspartate amino-transferase/amino alanine transferase (AST/ALT) tests occurred in about half (49%) of subjects, while 202 subjects (60%) were referred for gastrointestinal (GI) specialist evaluation and 49 patients (14% of all, 25% of those referred to a GI specialist) had specific treatment for hepatitis C. Although well over half of patients (60%) had possible contraindications to HCV treatment, including heavy alcohol use, few were referred for chemical dependency therapy. CONCLUSIONS: In this community, follow-up and treatment related to HCV were limited. Attention to prevention of disease-accelerating co-infections was only modest. Referral or documented recommendations for treatment of alcoholism or heavy chronic alcohol ingestion were minimal.