Using Structural Equation Modeling and Medicaid Data to Characterize the Hepatitis C Syndemic

Music City Center 

Hepatitis C and HIV have drivers that interact to exacerbate each outcome. We used structural equation modeling (SEM) to characterize the hepatitis C and HIV syndemic among Medicaid beneficiaries.
We used CMS data to identify beneficiaries with chronic hepatitis C, defined as having an HCV RNA test code index date from 2016 to 2020 followed by an ICD-10 chronic code ≥1 day after the index date. We included persons aged 18-64 enrolled in Medicaid for ≥12 months before and after the index date not dually enrolled in Medicare. SEM quantified relationships of factors before the index date with HIV diagnosis afterward. Each factor was a continuous construct representing number of overdoses, substance use disorders (SUDs), and mental health disorders (MHDs). The model allowed for correlation between constructs to estimate odds ratios (ORs), controlling for age, sex, and state.
A total of 467,340 beneficiaries with chronic hepatitis C were included. Each construct was significantly associated with HIV: MHDs (OR= 1.11), overdoses (OR=1.14), and SUDs (OR=1.29). Future modeling will include beneficiaries without hepatitis C and social latent factors to better characterize the syndemic.

structural equation modeling

factor model

hepatitis C

syndemic

Medicaid 

Mental Health Statistics Section