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Excess mortality rates in a cohort of patients infected with the hepatitis C virus: a prospective study
  1. Keith Neal (keith.neal{at}nottingham.ac.uk)
  1. Nottingham University Hospital, United Kingdom
    1. William Lucien Irving (will.irving{at}nottingham.ac.uk)
    1. University of Nottingham, United Kingdom

      Abstract

      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

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