{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T02:19:48Z","timestamp":1787624388745,"version":"build-2736575974"},"reference-count":43,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,2,17]],"date-time":"2024-02-17T00:00:00Z","timestamp":1708128000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100005564","name":"Gilead Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005564","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Viral Hepatitis"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The emergency department (ED) has increasingly become an important public health partner in non\u2010targeted 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\u2010related demographic shift, including subsequent linkage success and linkage barriers, from the perspective of an ED\u2010based 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\u201345), Baby Boomer (BB) (1946\u201364), Generation X (Gen X) (1965\u201380), Millennial (1981\u201396) and Generation Z (1997\u20132012). Descriptive statistics and chi\u2010square 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\u2010positive 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\u2010positive patients, white (45.5%), male (47.2%) and Millennial (49.7%) individuals were most likely to be RNA\u2010positive. Overall, 28.1% of the RNA\u2010positive cohort successfully linked to care; linkage to care rates were significantly higher in older generations (38.1% in BB vs. 17.8% in Millennials) (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.00001). 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) (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.00001). Older generations (SG and BB) were more likely to be impacted by competing medical comorbidities (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.00001). The ED population represents a particularly vulnerable, at\u2010risk cohort with a high prevalence of HCV and linkage to care barriers. While past HCV\u2010specific 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.<\/jats:p>","DOI":"10.1111\/jvh.13930","type":"journal-article","created":{"date-parts":[[2024,2,17]],"date-time":"2024-02-17T08:44:52Z","timestamp":1708159492000},"page":"233-239","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Birth <scp>cohort\u2010specific<\/scp> consideration in an Emergency Department Hepatitis C Testing Programme: A description of <scp>age\u2010related<\/scp> characteristics and outcomes"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3040-436X","authenticated-orcid":false,"given":"Lauren A.","family":"Walter","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myles","family":"Prados","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Audrey","family":"Lloyd","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvie","family":"Sontheimer","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Boston Medical Center  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Heimann","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel B.","family":"Rodgers","sequence":"additional","affiliation":[{"name":"Division of Acute Care Surgery, Department of Surgery University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Delissa T.","family":"Hand","sequence":"additional","affiliation":[{"name":"O'Neal Comprehensive Cancer Center University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Franco","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,2,17]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v24.i44.4959"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw111"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6914a2"},{"key":"e_1_2_10_5_1","unstructured":"Centers for Disease Control and Prevention.CDC Now Recommends all Baby Boomers Receive One\u2010Time Hepatitis C Test.2012. Retrieved from.https:\/\/www.cdc.gov\/nchhstp\/newsroom\/2012\/hcv\u2010testing\u2010recs\u2010pressrelease.html"},{"key":"e_1_2_10_6_1","unstructured":"Centers for Disease Control and Prevention.Hepatitis C.2013.https:\/\/www.cdc.gov\/vitalsigns\/hepatitisc\/index.html"},{"key":"e_1_2_10_7_1","unstructured":"Centers for Disease Control and Prevention.2022 Viral Hepatitis National Progress Report.2022. Retrieved from.https:\/\/www.cdc.gov\/hepatitis\/policy\/npr\/2022\/index.htm"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2017.304201"},{"key":"e_1_2_10_9_1","unstructured":"Centers for Disease Control and Prevention.Today's Heroin Epidemic.2015.https:\/\/www.cdc.gov\/vitalsigns\/heroin\/index.html"},{"key":"e_1_2_10_10_1","unstructured":"KFF.Opioid overdose deaths by age group.2022. Retrieved from.https:\/\/www.kff.org\/other\/state\u2010indicator\/opioid\u2010overdose\u2010deaths\u2010by\u2010age\u2010group\/?currentTimeframe=0&sortModel=%7B%22colId%22%3A%22Location%22%2C%22sort%22%3A%22asc%22%7D"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/YCO.0000000000000717"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph182212259"},{"key":"e_1_2_10_13_1","unstructured":"Hepatitis C Online.Recommendations for hepatitis C screening \u2013 core concepts.2020. Retrieved from.https:\/\/www.hepatitisc.uw.edu\/pdf\/screening\u2010diagnosis\/recommendations\u2010screening\/core\u2010concept\/all"},{"key":"e_1_2_10_14_1","unstructured":"Centers for Disease Control and Prevention.FastStats \u2013 Emergency Department visits.2022. Retrieved from.https:\/\/www.cdc.gov\/nchs\/fastats\/emergency\u2010department.htm"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.27410"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6919a1"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2019.11.034"},{"key":"e_1_2_10_18_1","unstructured":"Alabama Department of Public Health (ADPH).Access to care. Accessed on September 1 2023.https:\/\/www.alabamapublichealth.gov\/healthrankings\/access\u2010to\u2010care.html"},{"key":"e_1_2_10_19_1","unstructured":"KFF.Election: 2020 State health care snapshots.2020. 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