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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
From 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
From 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
From 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
From 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).
BUS
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Sveta Mohanan
From 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).
MD
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Mark W. Russo
From 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).
MD
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Michael Leonard
From 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
From 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
From 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
From 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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Article Figures & Data

Figures

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  • Figure 1.
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    Figure 1.

    Hepatitis C transmission risk by census tract in Mecklenburg County, NC. Abbreviation: HCV, hepatitis C virus.

  • Figure 2.
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    Figure 2.

    Social Determinants of Health (SDOH) index indicating the level of need by census tract in Mecklenburg County, NC.

  • Figure 3.
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    Figure 3.

    Hepatitis C transmission risk by census tract in Mecklenburg County, NC, with priority tracks from Social Determinants of Health (SDOH) Level of Need. Abbreviation: HCV, hepatitis C virus.

Tables

  • Figures
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    Table 1.

    Variables Identified by a Literature Review and the Social and Economic Team Committee Associated with Hepatitis C Transmission Risk and Social Determinants of Health Level of Need

    Variable Name
    Literature ReviewSocial and Economic Team Committee
    Low incomeIndividuals with less than a high school education
    Racial minoritiesHouseholds with no/limited English
    Poor access to healthcare servicesSingle parent households
    Injection drug useLow access to food sources
    Baby Boomer birth cohortMedian household income
    Uninsured/under-insured/publicly insuredUnemployed individuals
    HomelessnessHouseholds living in rental housing
    Current or history of incarcerationHouseholds paying >30% of income for rent
    Households without transportation
    Crowded households (>1 person per room)
    • View popup
    Table 2.

    Social Determinants of Health Variables Collected for Mecklenburg County, NC, Census Tracts Used to Identify Populations at Risk for Hepatitis C Infection

    Variable NameDefinition and Source
    Individuals with less than a high school educationPercentage of individuals over the age of 25 who have not completed a high school education*
    Households with no/limited EnglishPercentage of households over the age of 5 who speak no or limited English at home*
    Single-parent householdsPercentage of households who have only 1 parent present in household*
    Low access to food sourcesPercentage of the population living more than ½ mile (urban areas) or more than 10 miles (rural areas) from the nearest supermarket, supercenter, or large grocery store†
    Median household incomeMedian household income*
    Individuals living below the federal poverty linePercentage of households living below the federal poverty line*
    Unemployed individualsPercentage of individuals ages 16 to 64 in the civilian labor force and not employed divided by the number of individuals ages 16 to 64 in the civilian labor force*
    Uninsured individualsPercentage of individuals who do not have any form of health insurance*
    Households living in rental housingPercentage of households living in rental housing*
    Households paying >30% of income for rentPercentage of households who are paying greater than 30% of their income in housing*
    Households without transportationPercentage of households without access to a vehicle*
    Crowded households (>1 person per room)Percentage of households who have more than 1 person per room*
    • ↵* US Census.

    • ↵† US Department of Agriculture.

    • View popup
    Table 3.

    Hepatitis C Transmission Risk Variables Collected for Mecklenburg County, NC, Census Tracts Used to Identify Populations at Risk for Hepatitis C Infection

    Variable NameDefinition and Source
    Percent Caucasian populationCaucasian population divided by total population*
    Percent of population born 1945–1965Population born between 1945 and 1965 divided by total population*
    Prevalence of drug useNumber of patients who indicate they currently or previously used drugs divided by population†
    Prevalence of hepatitis C infectionNumber of patients who have been diagnosed with hepatitis C divided by the total number of patients†
    • ↵* US Census.

    • ↵† Atrium Health, US Census.

    • View popup
    Table 4.

    Validation of the Hepatitis C Transmission Risk Index Using Multiple Linear Regression

    PredictorsPrevalence of Hepatitis C Infection
    B (SE B)P Value
    Intercept0.0004 (0.00069)0.49
    Percent Caucasian Population−0.0014 (0.00094)0.13
    Percent of Population Born 1945-19650.0043 (0.0033)0.20
    Prevalence of Drug Use0.78 (0.042)<0.001*
    N233
    R20.71
    • ↵* P values in bold are significant.

    • B, Coefficient Estimate; SE B, Coefficient – Standard Error; R2, Multiple R-Squared.

    • View popup
    Table 5.

    Validation of the Social Determinants of Health Level of Need Index Using Multiple Linear Regression

    PredictorsPrevalence of Hepatitis C InfectionP Value*
    B (SE B)
    Intercept0.0067 (0.0018)<0.001
    Individuals with less than a high school education−0.00099 (0.0064)0.87
    Households with no/limited English−0.024 (0.0074)0.001
    Single-parent households−0.0074 (0.0041)0.07
    Low access to food sources−0.000081 (0.00056)0.88
    Median household income−0.00000035 (0.00000019)0.009
    Individuals living below the federal poverty Line0.014 (0.0054)0.009
    Unemployed individuals0.0023 (0.0084)0.79
    Uninsured individuals0.0078 (0.0056)0.16
    Households living in rental housing−0.0025 (0.0018)0.17
    Households paying >30% of income for rent−0.0082 (0.0044)0.06
    Households without transportation0.036 (0.0056)<0.001
    Crowded households (>1 person per room)−0.0078 (0.013)0.60
    N233
    R20.50
    • ↵* P values in bold are significant.

    • B, Coefficient Estimate; SE B, Coefficient – Standard Error; R2, Multiple R-Squared.

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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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