All-Cause, Liver-Related, and Non–Liver-Related Mortality Among HCV-Infected Individuals in the General US Population

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http://cid.oxfordjournals.org/content/53/2/150.abstract?etoc

All-Cause, Liver-Related, and Non–Liver-Related Mortality Among HCV-Infected

Individuals in the General US Population

Samer S. El-Kamary1,2,3,

Ravi Jhaveri4,5, and

D. Shardell1

+ Author Affiliations

1Department of Epidemiology and Public Health

2Department of Pediatrics

3Center for Vaccine Development, University of land School of Medicine,

Baltimore, land

4Division of Infectious Diseases, Department of Pediatrics

5Department of Molecular Genetics and Microbiology, Duke University School of

Medicine, Durham, North Carolina

Correspondence: Samer S. El-Kamary, MD, MPH, Department of Epidemiology and

Public Health, Department of Pediatrics, Center for Vaccine Development,

University of land School of Medicine, 660 West Redwood St, HH102B,

Baltimore, MD 21201 (selkamar@...).

Abstract

Background. Liver-related mortality among those infected with hepatitis C

virus (HCV) has been described, but little is known about non–liver-related

mortality. Our objective was to determine HCV-associated all-cause, liver-, and

non–liver-related mortality in the general US population.

Methods. A prospective cohort study of 9378 nationally representative adults

aged 17–59 years was performed utilizing the Third National Health and

Nutrition Examination Survey (NHANES III) Linked Mortality File that was made

publicly available in 2010. HCV status was assessed from 1988 to 1994, with

mortality follow-up of the same individuals through 2006.

Results. There were 614 deaths over a median follow-up of 14.8 years. After

adjusting for all covariate risk factors, HCV chronic infection had a 2.37 times

higher all-cause mortality rate ratio [MRR] (95% CI: 1.28–4.38; P = .008), a

26.46 times higher liver-related MRR (95% CI: 8.00–87.48; P < .001), and 1.79

times higher non–liver-related MRR (95% CI: .77–4.19; P = .18), compared

with being HCV-negative. This represents an estimated 2.46 million US adults

aged 17–59 years with chronic HCV infection who had an estimated 31,163 deaths

from all causes per year, of which 57.8% (95% CI: 21.9%–77.2%) were

attributable to HCV. Among those, there was an estimated 9569 liver-related

deaths per year, of which 96.2% (95% CI: 87.5–98.9%) were attributable to HCV.

Non–liver-related deaths were not significantly associated with HCV status.

Conclusions. Chronic HCV all-cause mortality is more than twice that of

HCV-negative individuals. This suggests that those with chronic HCV infection

are at a higher risk of death even after accounting for liver-related morbidity

and should be closely monitored.

Received January 17, 2011.

Accepted April 7, 2011.

© The Author 2011. Published by Oxford University Press on behalf of the

Infectious Diseases Society of America. All rights reserved. For Permissions,

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