Objective: We analysed the Trent Hepatitis C cohort to determine standardised mortality ratios in patients infected with hepatitis C virus, and to identify risk factors and associations with all-cause and liver- related mortality.
Design: Cohort study.
Setting: Patients with hepatitis C virus infection attending secondary care within the Trent region of England.
Patients: 2285 patients with hepatitis C, followed for one 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 3 times higher than those expected in the 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. For liver-related mortality age, treatment, liver biopsy fibrosis and mean alcohol consumption were predictors. HCV was mentioned on 23% of death certificates overall, and 52% of those from patients dying of a liver-related cause.
Conclusions: Our findings demonstrate that the death rate in patients infected with hepatitis C is 3 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.
- Hepatitis C virus
- Mortality rates