Design: Secondary analysis of a pragmatic randomised screening trial
Population: 147,498 adult ED patients at 3 US centres; 10.3% preferred a language other than English
Primary outcome: Hepatitis C test offer and acceptance
Effect: Targeted: offer RR 0.75 (0.70 to 0.79); universal: offer RR 1.00 (0.97 to 1.04)

DETECT Hep C randomised 147,498 adult emergency department visits at three US centres to targeted or non-targeted (universal) hepatitis C screening. This secondary analysis looked at the 10.3% who preferred a language other than English.

Under targeted screening, these patients were less likely to be offered a test (RR 0.75, 95% CI 0.70 to 0.79) and to accept it (RR 0.69). Under universal screening, the offer rate was the same (RR 1.00), though acceptance remained lower (RR 0.82).

Risk-based screening relies on staff conversations about risk, which language barriers make harder. A universal offer removes that step. The same logic applies to any emergency department screening programme serving patients who speak many languages.

Universal offers of hepatitis C testing reduce gaps created by risk-based selection
Use interpreters or translated materials when offering screening tests
Expect lower acceptance among patients with language barriers even when everyone is offered
Link positive screening results to treatment pathways before discharge

Why it matters

Risk-based screening can quietly exclude the patients who find it hardest to discuss risk.

The statistics, in plain English

An RR of 0.75 means patients preferring another language were offered testing about a quarter less often under targeted screening. This is a secondary, observational comparison within a randomised trial, and results varied between sites.