The emergency department (ED) has increasingly become an important public health partner in non-targeted hepatitis C virus (HCV) testing and referral to care efforts. HCV has traditionally been an infection associated with the Baby Boomer generation; however, recent exacerbation of the opioid epidemic has resulted in a growing number of younger cohorts, namely Millennials, also impacted by HCV. Examination of this age-related demographic shift, including subsequent linkage success and linkage barriers, from the perspective of an ED-based testing and linkage programme may have implications for future population and health systems interventions. A retrospective descriptive chart review was performed, inclusive of data from August 2015 through December 2020. We compared the quantity of positive HCV screening antibody (Ab) and confirmatory (RNA) tests and further considered linkage rates and correlative demographics (e.g. gender, race). Patient barriers to HCV care linkage (e.g. substance misuse, lack of health insurance, homelessness) were also evaluated. The data set was disaggregated by birth cohort to include Silent Generation (SG) (1928–45), Baby Boomer (BB) (1946–64), Generation X (Gen X) (1965–80), Millennial (1981–96) and Generation Z (1997–2012). Descriptive statistics and chi-square analysis were performed. Overall, 83,817 patients were tested for HCV (50.6% of eligible); 6187 (7.4%) were HCV Ab positive, and 2665 were HCV RNA positive (3.2%). RNA-positive individuals were more likely to be white (70.4%) and male (67.7%); generational distribution was similar (BB 33.3%, Gen X 32.0% and Millennials 32.7%). Amongst Ab-positive patients, white (45.5%), male (47.2%) and Millennial (49.7%) individuals were most likely to be RNA-positive. Overall, 28.1% of the RNA-positive cohort successfully linked to care; linkage to care rates were significantly higher in older generations (38.1% in BB vs. 17.8% in Millennials) (p < .00001). Over 90% were identified as having at least one linkage to care barrier. Younger generations (Gen X and Millennials) were disproportionately impacted by linkage barriers, including incarceration, lack of health insurance, history of mental health and substance use disorders, as well as history of or active injection drug use (IDU) (p < .00001). Older generations (SG and BB) were more likely to be impacted by competing medical comorbidities (p < .00001). The ED population represents a particularly vulnerable, at-risk cohort with a high prevalence of HCV and linkage to care barriers. While past HCV-specific recommendations and interventions have focused on Baby Boomers, this data suggests that younger generations, including Gen X and Millennials, are increasingly affected by HCV and face disparate social risk and social need factors which impede definitive care linkage and treatment.

中文翻译：

---

急诊科丙型肝炎检测计划中针对出生队列的具体考虑：年龄相关特征和结果的描述

急诊科 (ED) 日益成为非针对性丙型肝炎病毒 (HCV) 检测和转诊护理工作中的重要公共卫生合作伙伴。HCV 传统上是一种与婴儿潮一代相关的感染。然而，最近阿片类药物流行的加剧导致越来越多的年轻群体，即千禧一代，也受到丙肝病毒的影响。从基于 ED 的测试和联系计划的角度来检查这种与年龄相关的人口变化，包括随后的联系成功和联系障碍，可能会对未来的人口和卫生系统干预措施产生影响。我们进行了回顾性描述性图表审查，包括 2015 年 8 月至 2020 年 12 月的数据。我们比较了阳性 HCV 筛查抗体 (Ab) 和确证 (RNA) 检测的数量，并进一步考虑了连锁率和相关人口统计数据（例如性别、种族） 。还评估了 HCV 护理联系的患者障碍（例如药物滥用、缺乏健康保险、无家可归）。数据集按出生队列分类，包括沉默的一代（SG）（1928-45）、婴儿潮一代（BB）（1946-64）、X一代（Gen X）（1965-80）、千禧一代（1981-96）和Z世代（1997-2012）。进行了描述性统计和卡方分析。总体而言，共有 83,817 名患者接受了 HCV 检测（符合条件的患者占 50.6%）；6187 例（7.4%）HCV Ab 阳性，2665 例 HCV RNA 阳性（3.2%）。RNA 阳性个体更有可能是白人 (70.4%) 和男性 (67.7%)；代际分布相似（BB 33.3%、X 一代 32.0% 和千禧一代 32.7%）。在 Ab 阳性患者中，白人 (45.5%)、男性 (47.2%) 和千禧一代 (49.7%) 最有可能呈 RNA 阳性。总体而言，28.1% 的 RNA 阳性队列成功与护理相关；老一代人与护理率的联系显着较高（BB 为 38.1%，千禧一代为 17.8%）（p  < .00001）。超过 90% 的人被认为与护理障碍至少有一种联系。年轻一代（X 一代和千禧一代）受到连锁障碍的影响尤为严重，包括监禁、缺乏健康保险、心理健康史和物质使用障碍，以及注射毒品 (IDU) 史或主动注射吸毒史 (p <  .00001 ）。老一代（SG 和 BB）更有可能受到竞争性医疗合并症的影响 ( p  < .00001)。急诊科人群是一个特别脆弱的高危人群，丙肝病毒感染率很高，并且与护理障碍有关。虽然过去针对 HCV 的建议和干预措施主要针对婴儿潮一代，但这些数据表明，包括 X 一代和千禧一代在内的年轻一代越来越多地受到 HCV 的影响，并面临着不同的社会风险和社会需求因素，这些因素阻碍了明确的护理联系和治疗。