Causes of death after diagnosis of hepatitis B or hepatitis C infection: a large

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The Lancet

Volume 368, Issue 9539 , 9 September 2006-15 September 2006, Pages 938-945

Causes of death after diagnosis of hepatitis B or hepatitis C infection: a

large community-based linkage study

Ms Janaki Amin MPH (Hons)a, , , G Law PhDa, Mark Bartlett MPHa, Prof

M Kaldor PhDa and J Dore PhDa

aNational Centre in HIV Epidemiology and Clinical Research, University of

New South Wales, NSW 2010, Australia

Available online 7 September 2006.

Refers to: Prevention of mortality from hepatitis B and hepatitis C, The

Lancet, Volume 368, Issue 9539, 9 September 2006-15 September 2006, Pages

896-897

Eugene R Schiffa,

Referred to by: Prevention of mortality from hepatitis B and hepatitis C,

The Lancet, Volume 368, Issue 9539, 9 September 2006-15 September 2006,

Pages 896-897

Eugene R Schiffa,

Summary

Background

Hepatitis B and hepatitis C virus infections are common causes of death

related to liver disease. In this large study, we aimed to investigate all

cause mortality of the viruses in a community-based setting.

Methods

In the study population, 39 109 people had hepatitis B, 75 834 had hepatitis

C, and 2604 had hepatitis B and hepatitis C co-infection, notified to the

New South Wales state health department, Australia, between 1990 and 2002.

Their data were probabilistically linked to the National Death Index.

Standardised mortality ratios for all causes of death were calculated and

adjusted for age, sex, and calendar year.

Results

The number of deaths identified by the linkage were 1233 (3·2%) for

hepatitis B, 4008 (5·3)% for hepatitis C, and 186 (7·1)% for hepatitis B and

C co-infection. Raised risk of liver-related death (standardised mortality

ratios 12·2, 95% CI 10·7–13·9; 16·8, 15·4–18·3, and 32·9, 23·1–46·7, for

hepatitis B, hepatitis C, and hepatitis B and C co-infected patients,

respectively) and drug-induced death (1·4, 1·0–2·0; 19·3, 18·1–20·5; and

24·7, 18·2–33·5, respectively) were detected. In people with hepatitis C,

raised risk of dying from drug-related causes was significantly greater than

from liver-related causes (p=0·012), with the greatest excess risk in women

aged 15–24 years (56·9, 39·2–79·9).

Interpretation

All groups had increased risk of liver-related death compared with the

standard population, with the greatest excess in people diagnosed with

hepatitis B and hepatitis C co-infection. Our data highlight that young

people with hepatitis C and with co-infection face a higher mortality risk

from continued drug use than from their infection, whereas the main cause of

hepatitis B death was liver related.

Correspondence to: Ms Janaki Amin

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