Excess mortality rates in a cohort of patients infected with the hepatitis C virus: a prospective study
- Keith R Neal,
- on behalf of the Trent Hepatitis C Study Group*
- Correspondence to:
Professor W L Irving
Department of Microbiology, University Hospital, Queen’s Medical Centre, Nottingham NG7 2UH, UK; will.irving{at}nottingham.ac.uk
- Accepted 2 March 2007
- Revised 26 January 2007
- Published Online First 7 March 2007
Abstract
Objective: We analysed the Trent Hepatitis C cohort to determine standardised mortality ratios in patients infected with hepatitis C virus (HCV), and to identify risk factors and associations with all-cause and liver-related mortality.
Design: Cohort study.
Setting: Patients with HCV infection attending secondary care within the Trent region of England.
Patients: 2285 patients with hepatitis C, followed for 1 year or more.
Main outcome measures: The death rate in the cohort was compared to that seen in an age- and sex-matched English population. We performed Cox regression analyses to identify factors predictive of all-cause mortality and deaths from liver disease.
Results: Standardised mortality ratios in the cohort were three times higher than those expected in the general population of England. The excess deaths were due to liver-related causes and those associated with a drug-using lifestyle. Significant independent predictors of all-cause mortality were age, sex, treatment (protective) and liver biopsy fibrosis. Age, treatment, liver biopsy fibrosis and mean alcohol consumption were predictors of liver-related mortality. HCV was mentioned on 23% of death certificates overall, and on 52% of those of patients dying from a liver-related cause.
Conclusions: Our findings demonstrate that the death rate in patients infected with hepatitis C is three times higher than expected. Severity of disease is associated with a worse prognosis, whilst treatment improves outcome, particularly in those who respond. Use of death certificate data on HCV infection for planning purposes will result in considerable under-estimation of the HCV-related disease burden.
- HCC, hepatocellular cancer
- HCV, hepatitis C virus
- NHSCR, National Health Service Central Register
- SMR, standardised mortality ratio
Footnotes
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↵* The Trent Hepatitis C Study Group: Derby City Hospital: Dr A Austin, Consultant Gastroenterologist; Dr JG Freeman, Consultant Gastroenterologist; Mrs M Jackson, Hepatitis Specialist Nurse; Leicester Royal Infirmary/University of Leicester: Dr A McGregor, Consultant Histopathologist; Ms J Laurenti, Specialist Hepatitis Nurse; Professor KR Nicholson, Consultant in Infectious Diseases; Dr M Wiselka, Senior Lecturer in Infectious Diseases; Lincoln County Hospital: Dr J Harvey, Consultant Histopathologist; Dr BB Scott, Consultant Gastroenterologist; Nottingham University Hospital/University of Nottingham: Dr DA Ansell, Consultant Histopathologist; Professor RG Finch, Professor of Infectious Diseases; Ms K Jack, Specialist Hepatitis Nurse; Mrs M Holliday, Specialist Hepatitis Nurse; Professor WL Irving, Professor of Virology (Chair); Dr KR Neal, Senior Lecturer in P H Medicine & Epidemiology; Ms M Nicholls, Specialist Hepatitis Nurse; Ms S Ratib, Trent HCV Study Co-ordinator; Dr SD Ryder, Consultant Hepatologist; Dr BJ Thomson, Senior Lecturer in Infectious Diseases; Dr A Zaitoun, Consultant Histopathologist; National Blood Authority, Trent Centre: Dr DA Jones, Consultant Haematologist (Group Secretary); Royal Hallamshire Hospital, Sheffield/University of Sheffield: Dr J Bremner, Consultant Virologist, Sheffield Virology Consortium; Dr A Dube, Consultant Histopathologist; Ms J Fryer, Specialist Hepatitis Nurse; Dr D Gleeson, Consultant Gastroenterologist; Professor S Green, Consultant in Infectious Diseases; Mr G Harrison, Data Manager; Professor G Kudesia, Consultant Virologist, Sheffield Virology Consortium; Ms E McFarlane, Specialist Hepatitis Nurse; Professor MW McKendrick, Consultant in Infectious Diseases; Mr R Poll, Consultant Nurse Specialist; Mrs F Rayner, Specialist Hepatitis Nurse; Professor Sir JCE Underwood, Professor of Pathology; Dr S Whittaker, Clinical Psychologist; St James’s University Hospital, Leeds: Dr C Millson, Consultant Hepatologist; Mrs S Sheridan, Specialist Hepatitis Nurse; Ms C Wigglesworth, Specialist Hepatitis Nurse; Dr J Wyatt, Consultant Histopathologist.
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Published Online First 7 March 2007
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This study was supported by a grant to the Trent Hepatitis C Study Group from the Department of Health.
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Competing interests: None.
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Writing committee: Dr Keith R Neal; Ms Sheena Ramsay, Department of Epidemiology and Public Health, University of Nottingham; Dr Brian J Thomson; Professor William L Irving, Department of Microbiology and Infectious Diseases, University of Nottingham.
