Trends in mortality after diagnosis of hepatitis B or C infection: 1992–2006

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Trends in mortality after diagnosis of hepatitis B or C infection: 1992–2006

Journal of Hepatology, 04/27/2011

Walter SR et al. - Improvements in hepatitis B virus (HBV) treatment and uptake

have most likely reduced non- hepatitis C virus (HCV) liver-related mortality.

HCV drug-related mortality remained low compared to pre-2002 levels, likely due

to changes in opiate supply, and maintenance or improvement in harm reduction

strategies.

Methods

• HBV and HCV cases notified to the New South Wales (NSW) Health Department

between 1992 and 2006 were linked to cause of death data and HIV/AIDS

notifications.

• Mortality rates and standardised mortality ratios (SMRs) were calculated using

person time methodology, with NSW population rates used as a comparison.

• The study cohort comprised 42,480 individuals with HBV mono-infection and

82,034 with HCV mono-infection.

Results• HIV co-infection increased the overall mortality rate three to 10-fold

compared to mono-infected groups.

• Liver-related deaths were associated with high excess risk of mortality in

both HBV and HCV groups (SMR 10.0, 95% CI 9.0-11.1; 15.8, 95% CI 14.8-16.8).

• Drug-related deaths among the HCV group also represented an elevated excess

risk (SMR 15.4, 95% CI 14.5-16.3).

• Rates of hepatocellular carcinoma (HCC)-related death remained steady in both

groups.

• A decrease in non-HCC liver-related deaths was seen in the HBV group between

1997 and 2006, but not in the HCV group.

• After a sharp decrease between 1999 and 2002, drug-related mortality rates in

the HCV group have been stable.

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Journal of Hepatology

Volume 54, Issue 5, May 2011, Pages 879-886

--------------------------------------------------------------------------------

doi:10.1016/j.jhep.2010.08.035 |

European Association for the Study of the Liver Published by

Elsevier Ireland Ltd.

Research Article

Trends in mortality after diagnosis of hepatitis B or C infection: 1992–2006

R. Walter1, 2, Hla-Hla Thein1, Janaki Amin1, F. Gidding1, Kate

Ward2, G. Law1, 3 and J. Dore1, ,

1 National Centre in HIV Epidemiology and Clinical Research, The University of

New South Wales, Sydney, Australia

2 New South Wales Department of Health, Sydney, Australia

3 Storr Liver Unit, Westmead Hospital and Westmead Millennium Institute,

University of Sydney, Sydney, Australia

Received 1 June 2010; revised 30 July 2010; accepted 19 August 2010.

Available online 23 October 2010.

Background & Aims

Chronic hepatitis B (HBV) or C (HCV) virus infection has been associated with

increased risk of death, particularly from liver- and drug-related causes. We

examined specific causes of death among a population-based cohort of people

infected with HBV or HCV to identify areas of excess risk and examine trends in

mortality.

Methods

HBV and HCV cases notified to the New South Wales (NSW) Health Department

between 1992 and 2006 were linked to cause of death data and HIV/AIDS

notifications. Mortality rates and standardised mortality ratios (SMRs) were

calculated using person time methodology, with NSW population rates used as a

comparison.

Results

The study cohort comprised 42,480 individuals with HBV mono-infection and 82,034

with HCV mono-infection. HIV co-infection increased the overall mortality rate

three to 10-fold compared to mono-infected groups. Liver-related deaths were

associated with high excess risk of mortality in both HBV and HCV groups (SMR

10.0, 95% CI 9.0–11.1; 15.8, 95% CI 14.8–16.8). Drug-related deaths among the

HCV group also represented an elevated excess risk (SMR 15.4, 95% CI 14.5–16.3).

Rates of hepatocellular carcinoma (HCC)-related death remained steady in both

groups. A decrease in non-HCC liver-related deaths was seen in the HBV group

between 1997 and 2006, but not in the HCV group. After a sharp decrease between

1999 and 2002, drug-related mortality rates in the HCV group have been stable.

Conclusions

Improvements in HBV treatment and uptake have most likely reduced non-HCC

liver-related mortality. Encouragingly, HCV drug-related mortality remained low

compared to pre-2002 levels, likely due to changes in opiate supply, and

maintenance or improvement in harm reduction strategies