Hospitalisation of hepatitis C diagnosed persons in Scotland for decompensated cirrhosis: a population-based record-linkage study

Introduction: Few studies have examined progression to the decompensated stage of cirrhosis in hetereogenous populations of persons infected with the hepatitis C virus (HCV). We investigated hospitalisation for decompensated cirrhosis among all individuals who have been diagnosed with HCV in Scotland. Aims & Methods: The population studied consisted of 20¿969 individuals diagnosed with hepatitis C through laboratory testing in Scotland between 1991 and 30 June 2006. These data were linked to other national databases on (1) all in-patient hospital discharges to retrieve episodes with discharge diagnoses of cirrhotic complications or hepatic failure (ICD-10: R18, I850, I982, K721, K729, K704, K709), and (2) all HIV tests to determine HIV co-infection status. Results: 1027 individuals were admitted to hospital for the first time with decompensated cirrhosis during the follow-up period. The number of first-time admissions increased over the period 1996–2005, with an average annual change of 10.3%. The relative risk of hospitalisation was significantly greater for males (hazard ratio 1.3, 95% CI 1.1 to 1.6), for those with a previous alcohol-related hospital admission (hazard ratio¿=¿5.7, 95% CI 4.7 to 6.9), for HIV co-infected persons (hazard ratio 1.6, 95% CI 1.0 to 2.5), and for those aged over 30 years (30–39: hazard ratio 3.6, 95% CI 2.3 to 5.6; 40–49: hazard ratio 10.1, 95% CI 6.5 to 15.7; 50–59: hazard ratio 17.8, 95% CI 11.1 to 28.6; 60+: hazard ratio 29.5, 95% CI 17.7 to 49.1). Conclusion: The burden to the Scottish healthcare system from HCV-infected persons developing cirrhotic complications is increasing, due to the advancing age of this Scottish HCV-diagnosed population. Of the epidemiological risk factors examined, a history of alcohol-related hospitalisation was most strongly associated with progression to decompensated cirrhosis. A greater proportion of HCV-infected individuals needs to be identified, treated and educated about the importance of minimal alcohol consumption to achieve a greater impact on the morbidity of this disease.