Hepatitis C virus-related liver cancer among Medicaid recipients with schizophrenia, 2002–2012

Abstract

Nearly half of primary liver cancers are attributed to hepatitis C virus (HCV) infection. People living with schizophrenia have higher HCV prevalence and liver cancer mortality rates than the general population. Among Medicaid beneficiaries with HCV, we compared incident liver cancer diagnosis in recipients living with and without schizophrenia. Using Medicaid claims data, pooled logistic regression and time survival models we estimated adjusted incidence rates of liver cancer diagnosis and risk factors for those living with schizophrenia. During 2002–2012 (N = 104,469), incident liver cancer diagnosis ranged from 845 to 1602 per 100,000 person-years. Recipients living with versus without schizophrenia had lower diagnosis rates over the study period and lower cumulative incidence within common risk factors of liver disease progression (e.g., diabetes). However, rates were higher for those with comorbid human immunodeficiency virus (HIV) infection. Among recipients with schizophrenia, higher odds of liver cancer diagnosis was associated with having comorbid alcohol use disorder (OR=1.23; 95 % confidence interval [CI] =1.70–2.05), diabetes (OR=1.49; CI=1.36–1.64), hypertension (OR=1.49; CI=1.36–1.65), chronic hepatitis B (OR=2.57; CI=2.26–2.91), or ≥ 1 annual primary care visit (OR=1.65; CI=1.46–1.86). Black (versus White) recipients had lower odds of diagnosis (OR=0.77; CI=0.70–0.86). Given higher HCV prevalence and liver cancer mortality in this population, lower diagnosis rates may reflect insufficient liver cancer detection, potentially driving HCV-related excess mortality rates for individuals living with schizophrenia. Addressing metabolic abnormalities and alcohol use is critical to risk reduction in HCV-infected persons living with schizophrenia, especially those living with HCV-HIV coinfection or racially minoritized.