{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T16:21:43Z","timestamp":1790698903670,"version":"4.1.0"},"reference-count":45,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2022,12,6]],"date-time":"2022-12-06T00:00:00Z","timestamp":1670284800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"crossref","award":["PI18CIII\/00047 and PI17CIII\/00037"],"award-info":[{"award-number":["PI18CIII\/00047 and PI17CIII\/00037"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"crossref"}]},{"name":"R\u00edo-Hortega","award":["CM20CIII\/00001"],"award-info":[{"award-number":["CM20CIII\/00001"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,4,17]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>In 2015, hepatitis C treatment with direct-acting antivirals (DAAs) became free and widespread in Spain, significantly reducing hepatitis C\u2013related mortality. However, health interventions can sometimes widen health inequalities. The objective of this study is to assess the impact of DAA treatment on hepatitis C\u2013related mortality by educational level.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analyzed deaths from hepatitis C, unspecified liver cirrhosis, hepatocellular carcinoma, alcohol-related liver diseases, other liver diseases, and human immunodeficiency virus (HIV) disease among individuals living in Spain during 2012\u20132019 and aged \u226525 years. We calculated age-standardized mortality rates per million person-years by period, sex, and education. Using quasi-Poisson segmented regression models, we estimated the annual percent change in rates in pre- and postintervention periods by education level and the relative inequality index (RII).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Hepatitis C mortality rates among low, middle, and highly educated people decreased from 25.2, 23.2, and 20.3\/million person-years in the preintervention period to 15.8, 13.7, and 10.4 in the postintervention period. Mortality rates from other analyzed causes also decreased. Following the intervention, downward trends in hepatitis C mortality accelerated at all education levels, although more in highly educated people, and the RII increased from 2.1 to 2.7. For other analyzed causes of death, no favorable changes were observed in mortality trends, except for liver cirrhosis, hepatocellular carcinoma, HIV disease, and alcohol-related liver disease among higher educated people.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Results suggest that DAA treatments had a very favorable impact on hepatitis C mortality at all education levels. However, even in a universal and free healthcare system, highly educated people seem to benefit more from DAA treatment than less educated people.<\/jats:p><\/jats:sec>","DOI":"10.1093\/cid\/ciac928","type":"journal-article","created":{"date-parts":[[2022,12,6]],"date-time":"2022-12-06T22:40:50Z","timestamp":1670366450000},"page":"1423-1430","source":"Crossref","is-referenced-by-count":7,"title":["Free Access to Direct-Acting Antivirals in Spain: More Favorable Impact on Hepatitis C Mortality Among Highly Educated People"],"prefix":"10.1093","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7315-034X","authenticated-orcid":false,"given":"Julieta","family":"Politi","sequence":"first","affiliation":[{"name":"National School of Public Health, Instituto de Salud Carlos III , Madrid , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrique","family":"Regidor","sequence":"additional","affiliation":[{"name":"CIBER Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP) , Madrid , Spain"},{"name":"Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense , Madrid , Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria del Hospital Cl\u00ednico San Carlos (IdISSC) , Madrid , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Donat","sequence":"additional","affiliation":[{"name":"National School of Public Health, Instituto de Salud Carlos III , Madrid , Spain"},{"name":"CIBER Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP) , Madrid , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"Pulido","sequence":"additional","affiliation":[{"name":"CIBER Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP) , Madrid , Spain"},{"name":"Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense , Madrid , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Miguel","family":"Guerras","sequence":"additional","affiliation":[{"name":"National School of Public Health, Instituto de Salud Carlos III , Madrid , Spain"},{"name":"CIBER Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP) , Madrid , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregorio","family":"Barrio","sequence":"additional","affiliation":[{"name":"National School of Public Health, Instituto de Salud Carlos III , Madrid , Spain"},{"name":"CIBER Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP) , Madrid , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Jos\u00e9","family":"Belza","sequence":"additional","affiliation":[{"name":"National School of Public Health, Instituto de Salud Carlos III , Madrid , Spain"},{"name":"CIBER Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP) , Madrid , 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