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Research ArticleOriginal Research

Novel Models to Identify Census Tracts for Hepatitis C Screening Interventions

Thomas Ludden, Lindsay Shade, Jeremy Thomas, Brisa Urquieta de Hernandez, Sveta Mohanan, Mark W. Russo, Michael Leonard, Philippe J. Zamor, Charity G. Patterson and Hazel Tapp
The Journal of the American Board of Family Medicine May 2020, 33 (3) 407-416; DOI: https://doi.org/10.3122/jabfm.2020.03.190305
Thomas Ludden
Department of Family Medicine, Atrium Health, Charlotte, NC (TL, LS, JT, SM, HT); Department of Hepatology, Atrium Health, Charlotte, NC (MWR, PJZ); Department of Infectious Diseases, Atrium Health, Charlotte, NC (ML); Community Health, Atrium Health, Charlotte, NC (BUH); School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA (CGP).
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Lindsay Shade
Department of Family Medicine, Atrium Health, Charlotte, NC (TL, LS, JT, SM, HT); Department of Hepatology, Atrium Health, Charlotte, NC (MWR, PJZ); Department of Infectious Diseases, Atrium Health, Charlotte, NC (ML); Community Health, Atrium Health, Charlotte, NC (BUH); School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA (CGP).
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Jeremy Thomas
Department of Family Medicine, Atrium Health, Charlotte, NC (TL, LS, JT, SM, HT); Department of Hepatology, Atrium Health, Charlotte, NC (MWR, PJZ); Department of Infectious Diseases, Atrium Health, Charlotte, NC (ML); Community Health, Atrium Health, Charlotte, NC (BUH); School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA (CGP).
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Brisa Urquieta de Hernandez
Department of Family Medicine, Atrium Health, Charlotte, NC (TL, LS, JT, SM, HT); Department of Hepatology, Atrium Health, Charlotte, NC (MWR, PJZ); Department of Infectious Diseases, Atrium Health, Charlotte, NC (ML); Community Health, Atrium Health, Charlotte, NC (BUH); School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA (CGP).
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Sveta Mohanan
Department of Family Medicine, Atrium Health, Charlotte, NC (TL, LS, JT, SM, HT); Department of Hepatology, Atrium Health, Charlotte, NC (MWR, PJZ); Department of Infectious Diseases, Atrium Health, Charlotte, NC (ML); Community Health, Atrium Health, Charlotte, NC (BUH); School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA (CGP).
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Mark W. Russo
Department of Family Medicine, Atrium Health, Charlotte, NC (TL, LS, JT, SM, HT); Department of Hepatology, Atrium Health, Charlotte, NC (MWR, PJZ); Department of Infectious Diseases, Atrium Health, Charlotte, NC (ML); Community Health, Atrium Health, Charlotte, NC (BUH); School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA (CGP).
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Michael Leonard
Department of Family Medicine, Atrium Health, Charlotte, NC (TL, LS, JT, SM, HT); Department of Hepatology, Atrium Health, Charlotte, NC (MWR, PJZ); Department of Infectious Diseases, Atrium Health, Charlotte, NC (ML); Community Health, Atrium Health, Charlotte, NC (BUH); School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA (CGP).
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Philippe J. Zamor
Department of Family Medicine, Atrium Health, Charlotte, NC (TL, LS, JT, SM, HT); Department of Hepatology, Atrium Health, Charlotte, NC (MWR, PJZ); Department of Infectious Diseases, Atrium Health, Charlotte, NC (ML); Community Health, Atrium Health, Charlotte, NC (BUH); School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA (CGP).
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Charity G. Patterson
Department of Family Medicine, Atrium Health, Charlotte, NC (TL, LS, JT, SM, HT); Department of Hepatology, Atrium Health, Charlotte, NC (MWR, PJZ); Department of Infectious Diseases, Atrium Health, Charlotte, NC (ML); Community Health, Atrium Health, Charlotte, NC (BUH); School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA (CGP).
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Hazel Tapp
Department of Family Medicine, Atrium Health, Charlotte, NC (TL, LS, JT, SM, HT); Department of Hepatology, Atrium Health, Charlotte, NC (MWR, PJZ); Department of Infectious Diseases, Atrium Health, Charlotte, NC (ML); Community Health, Atrium Health, Charlotte, NC (BUH); School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA (CGP).
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Abstract

Background: Increased screening efforts and the development of effective antiviral treatments have led to marked improvement in hepatitis C (HCV) patient outcomes. However, many people in the United States are still believed to have undiagnosed HCV. Geospatial modeling using variables representing at-risk populations in need of screening for HCV and social determinants of health (SDOH) provide opportunities to identify populations at risk of HCV.

Methods: A literature review was conducted to identify variables associated with patients at risk for HCV infection. Two sets of variables were collected: HCV Transmission Risk and SDOH Level of Need. The variables were combined into indices for each group and then mapped at the census tract level (n = 233). Multiple linear regression analysis and the Pearson correlation coefficient were used to validate the models.

Results: A total of 4 HCV Transmission Risk variables and 12 SDOH Level of Need variables were identified. Between the 2 indexes, 21 high-risk census tracts were identified that scored at least 2 standard deviations above the mean. The regression analysis showed a significant relationship with HCV infection rate and prevalence of drug use (B = 0.78, P < .001). A significant relationship also existed with the HCV infection rate for households with no/limited English use (B = −0.24, P = .001), no car use (B = 0.036, P < .001), living below the poverty line (B = 0.014, P = .009), and median household income (B = −0.00, P = .009).

Conclusions: Geospatial models identified high-priority census tracts that can be used to map high-risk HCV populations that may otherwise be unrecognized. This will allow future targeted screening and linkage-to-care interventions for patients at high risk of HCV.

  • Hepatitis C
  • Regression Analysis
  • Risk Factors
  • Social Determinants of Health
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The Journal of the American Board of Family     Medicine: 33 (3)
The Journal of the American Board of Family Medicine
Vol. 33, Issue 3
May/June 2020
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Novel Models to Identify Census Tracts for Hepatitis C Screening Interventions
Thomas Ludden, Lindsay Shade, Jeremy Thomas, Brisa Urquieta de Hernandez, Sveta Mohanan, Mark W. Russo, Michael Leonard, Philippe J. Zamor, Charity G. Patterson, Hazel Tapp
The Journal of the American Board of Family Medicine May 2020, 33 (3) 407-416; DOI: 10.3122/jabfm.2020.03.190305

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Novel Models to Identify Census Tracts for Hepatitis C Screening Interventions
Thomas Ludden, Lindsay Shade, Jeremy Thomas, Brisa Urquieta de Hernandez, Sveta Mohanan, Mark W. Russo, Michael Leonard, Philippe J. Zamor, Charity G. Patterson, Hazel Tapp
The Journal of the American Board of Family Medicine May 2020, 33 (3) 407-416; DOI: 10.3122/jabfm.2020.03.190305
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