br Materials and methods Materials and methods
Materials and methods Materials and methods for this analysis, including sample stratification, measures, and an NHIS description are described in detail in the previously published study  with the exception that the 2016 data were added to supplement the results from the 2013–2015 data.
Discussion While we found screening prevalence was statistically increasing over time, the increases will likely have minimal impact from a public health perspective. As with our previous study , screening prevalence for baby boomers are continuing to increase by approximately 1% per year. And while the odds of screening increased by over 40% from 2013 to 2016, the actual screening prevalence only increased by 2.2%. When examining geographic region, baby boomers in the Midwest had a 22% lower odds of screening than those in the Northeast and the lowest odds of screening overall. This is particularly concerning considering recent research that has found three Midwest states have higher than average incidence of HCV infection and one of those states is more than double the national average . Furthermore, non-Hispanic Black individuals and Hispanic individuals continued to have lower odds of screening in every adjusted model except for the oldest age group. This is consistent with our previous findings and is concerning given a recent study found the prevalence of HCV RNA was highest among non-Hispanic Black individuals , and non-Hispanic Black patients with hepatocellular carcinoma have been shown to have higher cause-specific mortality . This study does have some limitations which indicate the results should be interpreted with caution. First, while the large sample is a strength, it Nutlin-3 also resulted in even small differences being statistically significant. Therefore, a statistically significant result should be interpreted while paying attention to whether the differences are clinically significant or would have a broader public health impact. Second, HCV screening is based on self-report and has not been verified with the patient records. However, screening prevalence based on self-report in our study is actually higher than screening prevalence reported in studies using health-record verified data [13,14], suggesting our results are more likely to overestimate rather than underestimate screening. Last, these data are cross sectional and we are not able to draw cause-effect conclusions. However, despite these limitations this study expands on our previous findings and reports screening prevalence using more up-to-date nationally representative data.
Conclusion These data show while HCV screening prevalence is increasing statistically over time, with only 14.1% of baby boomers reporting they have ever been screened for HCV, we are well below the recommend universal one time screening in this group . Randomized controlled trials of interventions aimed at increasing HCV screening have shown promising results . Future research should focus on disseminating these successful interventions and should highlight the importance of screening in the primary care setting and target groups that are disproportionately impacted by HCV-related disease (including non-Hispanic Black and Hispanic patients) or have documented lower odds of screening, including baby boomers and women.
Conflict of interest disclosures
Acknowledgments Drs. M. Kasting and A. Giuliano are supported, in part, by the National Cancer Institute of the National Institutes of Health-funded Center for Infection Research in Cancer (K05-CA181320; PI: Giuliano). Dr. M. Kasting was also supported by the National Cancer Institute of the National Institutes of Health (R25-CA090314; PI: Brandon) while micronutrients was working on this project. This work and Dr. R. Reich’s effort were supported, in part, by the Biostatistics Core at the H. Lee Moffitt Cancer Center & Research Institute, a National Cancer Institute designated Comprehensive Cancer Center (P30-CA076292; PI: Sellers). Dr. E Thomas us supported by a Bankhead-Coley Clinical Cancer Research Grant of the Florida Biomedical Research Program (7BCO3) at the University of Miami Sylvester Cancer Center.