{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T11:27:19Z","timestamp":1786706839769,"version":"build-2736575974"},"reference-count":33,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,2,15]],"date-time":"2026-02-15T00:00:00Z","timestamp":1771113600000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T32 DK 007634"],"award-info":[{"award-number":["T32 DK 007634"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In the United States (US), chronic hepatitis C virus (HCV) is the leading cause of hepatocellular carcinoma (HCC). Direct\u2010acting antivirals (DAAs) cure HCV and reduce HCC risk, but Medicaid DAA coverage varies across states.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>We assessed whether Medicaid DAA access was associated with trends in HCC\u2010related deaths.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We analyzed CDC WONDER death certificate data (1999\u20132023) to assess HCC\u2010related mortality. US states were grouped based on Medicaid DAA prior authorization restrictions using the Hepatitis C: State of Medicaid Access scoring system: A+\/A (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200928), B (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200911), and C\/D (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200912). We used NCI Joinpoint software to calculate the annual percentage change (APC) and average annual percent change (AAPC) in age\u2010adjusted death rate. State\u2010specific HCC crude death rates were analyzed before and after 2014, alongside changes in Medicaid DAA policies from 2014 to 2024.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Before 2017, HCC\u2010related death rates were positive in group A + \/A (APC 2.01, 1999\u20132017), group B (APC 3.40, 1999\u20132009), and group C\/D (APC 2.04, 1999\u20132023). Age\u2010adjusted death rates became negative in group A+\/A states (APC \u22120.19, 2017\u20132023), while death rates continued to be positive for group B states (APC 1.49, 2009\u20132023) and group C\/D states (APC 2.04, 2017\u20132023). The AAPC (1999\u20132023) was lowest in group A + \/A (1.46), followed by group B (2.28) and C\/D (2.04). From 2014 to 2024 accessibility to DAAs improved.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Increased DAA access was associated with reduced HCC\u2010related death rates. Improved HCV treatment could contribute to decreased HCC incidence and recurrence, enhance linkage to subspecialty care, and prevent liver\u2010related decompensation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.71624","type":"journal-article","created":{"date-parts":[[2026,2,15]],"date-time":"2026-02-15T17:08:47Z","timestamp":1771175327000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Less Restrictive Medicaid Policies for Direct\u2010Acting Antiviral Access Are Associated With Greater Declines in Hepatocellular Carcinoma Deaths"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-3135-2161","authenticated-orcid":false,"given":"Gabriel V.","family":"Lupu","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology The University of North Carolina  Chapel hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhagyashree","family":"Behera","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology The University of North Carolina  Chapel hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"IV","given":"A. Sidney","family":"Barritt","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology The University of North Carolina  Chapel hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0923-4300","authenticated-orcid":false,"given":"Sasha","family":"Deutsch\u2010Link","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology The University of North Carolina  Chapel hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Giang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy The University of North Carolina Health  Chapel hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2083-522X","authenticated-orcid":false,"given":"Ellen W.","family":"Green","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology The University of North Carolina  Chapel hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oren K.","family":"Fix","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology The University of North Carolina  Chapel hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil D.","family":"Shah","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology The University of North Carolina  Chapel hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hersh","family":"Shroff","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology The University of North Carolina  Chapel hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7163-2062","authenticated-orcid":false,"given":"Andrew M.","family":"Moon","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology The University of North Carolina  Chapel hill North Carolina USA"},{"name":"Lineberger Cancer Center The University of North Carolina  Chapel hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,15]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/HEP.0000000000000807"},{"key":"e_1_2_10_3_1","volume-title":"Success Story: Impact, Costs, and Effectiveness of Screening Recommendations for Hepatitis C","author":"CDC","year":"2024"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/HEP.0000000000000466"},{"key":"e_1_2_10_5_1","article-title":"U.S. Lags Behind Other Countries in Hepatitis\u2010C Treatment","author":"Alcorn T.","year":"2024","journal-title":"New York 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