Article Text

Download PDFPDF
Excess mortality rates in a cohort of patients infected with the hepatitis C virus: a prospective study
  1. Keith R Neal,
  2. on behalf of the Trent Hepatitis C Study Group*
  1. Department of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
  1. Correspondence to:
    Professor W L Irving
    Department of Microbiology, University Hospital, Queen’s Medical Centre, Nottingham NG7 2UH, UK; will.irving{at}


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
  • hepatitis C virus
  • mortality ratios
  • liver disease
  • death

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • * 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.

  • Published Online First 7 March 2007

  • This study was supported by a grant to the Trent Hepatitis C Study Group from the Department of Health.

  • Competing interests: None.

  • 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.

Linked Articles

  • Digest
    Robin Spiller Emad El-Omar