Social determinants of maternal health Pediatric HCV screening

Social determinants of maternal health Pediatric HCV screening

Jennifer Fleming, MD, FRCPC

Image source: Queen’s University

Social determinants of maternal health Pediatric HCV screening

Living in rural residences and high dependency communities may negatively impact compliance with guideline-recommended pediatric screening in children exposed to hepatitis C virus (HCV) in utero, results from a retrospective cohort study suggest.1

Using administrative health care data from 1780 children born to mothers with HCV RNA in Canada, the study highlights the impact of several social determinants of health on HCV screening at age 2 years and factors associated with increased odds of screening.1

According to the World Health Organization (WHO), an estimated 58 million people worldwide have chronic HCV infection, with 3.2 million cases affecting adolescents and children. Although hepatitis C virus is a less common form of transmission, it can be passed from an infected mother to her child. To achieve the World Health Organization’s global hepatitis strategy to reduce new hepatitis infections by 90% and deaths by 65% ​​by 2030, screening and treatment of this patient population is critical.2,3

Jennifer Flemming, MD, FRCPC, associate professor of medicine and public health sciences at Queen’s University, and colleagues wrote: “Undiagnosed infections in children increase the risk of liver-related complications and put families and Close contacts are exposed, thereby risking further spread.”1 “About whether and how [social determinants of health] May impact pediatric HCV screening. “

To further explore this association, researchers retrospectively examined administrative healthcare data for individuals covered by the Ontario Health Insurance Plan in Ontario, Canada. Information is obtained and accessed through ICES, a designated regulatory entity authorized to collect and use health data without an individual’s consent.1

The study included children born between January 1, 2000, and December 31, 2016, to individuals aged ≥15 years with evidence of HCV RNA positivity. Birth data are from the MOMBABY dataset, and children were followed until the end of 2018.1

The primary outcome of interest was guideline-recommended HCV screening for children exposed to HCV in utero at 2 years of age, defined as HCV Ab laboratory testing at 18 months of age or between 2 and 2 months of age. Indirect laboratory testing for HCV RNA or genotype. 24 months after birth.1

The primary study exposures were maternal community-level social determinants of health measured at the time of delivery and available in ICES data. Investigators assessed six domains: income quintile, dependence quintile, material deprivation quintile, housing instability quintile, ethnic diversity quintile and rural area.1

Other demographic data and confounders of interest included maternal age at delivery, HIV coinfection, hepatitis B virus coinfection, cirrhosis, alcohol and substance use disorders, and the Elixhauser comorbidity index.1

A total of 1780 children born to HCV RNA carriers were identified, of whom 29% (n = 516) were screened for HCV at 2 years of age. Median age at birth for pregnancy cohort 30 years (interquartile range) [IQR], 26–34) and 2% were coinfected with HIV. Within 1 year before conception or during pregnancy, 30% had seen a gastroenterologist, 13% had seen an infectious disease specialist, and 94% had seen an obstetrician-gynecologist.1

The majority of mothers live in the lowest income quintile (42%), which is also the quintile most vulnerable to material deprivation (41%), housing instability (38%) and racial diversity (26%) group, 11% of whom live in rural areas.After adjusting for covariates, maternal rural residence was associated with an 18% lower probability of screening at age 2 years (hazard ratio [RR], 0.82; 95% CI, 0.62-1.07). The researchers also noted that children living in the highest dependency quintile were 17% less likely to be screened for HCV (RR, 0.83; 95% CI, 0.64-1.08).1

further 1.18; 95% CI, 1.00-1.39) was associated with an increased probability of screening. In addition, the researchers noted that visits to gastrointestinal and infectious disease specialists were associated with a 28% increase in the odds of screening.1

“Our data suggest efforts to improve HCV screening in rural and remote areas, increase education on the importance of postpartum screening for HCV+ mothers and primary care providers, and understand barriers to screening among people living in high-dependency communities. , may translate into improved pediatric HCV screening,” the researchers concluded.1

refer to:

  1. Foley MK, Djerboua M, Kushner T, et al. Maternal community-level social determinants of health and their association with pediatric hepatitis C screening in children exposed to hepatitis C during pregnancy. Pediatric and perinatal epidemiology. https://doi.org/10.1111/ppe.13042
  2. World Health Organization. Hepatitis C Newsroom. July 18, 2023. Accessed February 2, 2024. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c
  3. World Health Organization. Eliminate hepatitis by 2030. hepatitis. Accessed: February 2, 2024. https://www.who.int/health-topics/hepatitis/elimination-of-hepatitis-by-2030

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