Liver mortality attributable to chronic hepatitis C virus infection in Denmark and Scotland: using spontaneous resolvers as the benchmark comparator

Hamish Innes, Sharon J. Hutchinson, Niels Obel, Peer B. Christensen, Esther J. Aspinall, David Goldberg, Henrik Krarap, Scott A. McDonald, Allan McLeod, Amanda Weir, Lars. H. Omland

Research output: Contribution to journalArticle

21 Downloads (Pure)

Abstract

Liver mortality among individuals with chronic hepatitis C (CHC) infection is common, but the relative contribution of CHC per se versus adverse health behaviors is uncertain. We explored data on spontaneous resolvers of hepatitis C virus (HCV) as a benchmark group to uncover the independent contribution of CHC on liver mortality. Using national HCV diagnosis and mortality registers from Denmark and Scotland, we calculated the liver mortality rate (LMR) for persons diagnosed with CHC infection (LMRchronic) and spontaneously resolved infection (LMRresolved), according to subgroups defined by age, sex, and drug use. Through these mortality rates, we determined subgroup-specific attributable fractions (AFs), defined as (LMRchronic - LMRresolved)/LMRchronic, and then calculated the total attributable fraction (TAF) as a weighted average of these AFs. Thus, the TAF represents the overall fraction (where 0.00 = not attributable at all; and 1.00 = entirely attributable) of liver mortality attributable to CHC in the diagnosed population. Our cohort comprised 7,005 and 21,729 persons diagnosed with HCV antibodies in Denmark and Scotland, respectively. Mean follow-up duration was 6.3-6.9 years. The TAF increased stepwise with age. It was lowest for death occurring at <45 years of age (0.21 in Denmark; 0.26 in Scotland), higher for death occurring at 45-59 years (0.69 in Denmark; 0.69 in Scotland), and highest for death at 60+years (0.92 in Denmark; 0.75 in Scotland). Overall, the TAF was 0.66 (95% confidence interval [CI]: 0.55-0.78) in Denmark and 0.55 (95% CI: 0.44-0.66) in Scotland. Conclusions: In Denmark and Scotland, the majority of liver death in the CHC-diagnosed population can be attributed to CHC—nevertheless, an appreciable fraction cannot, cautioning that liver mortality in this population is a compound problem that can be reduced, but not solved, through antiviral therapy alone.
Original languageEnglish
Pages (from-to)1506-1516
Number of pages11
JournalHepatology
Volume63
Issue number5
Early online date16 Jan 2016
DOIs
Publication statusPublished - May 2016

Fingerprint

Benchmarking
Scotland
Chronic Hepatitis C
Virus Diseases
Denmark
Hepacivirus
Mortality
Liver
Infection
Confidence Intervals
Population
Hepatitis C Antibodies
Health Behavior
Antiviral Agents
Pharmaceutical Preparations

Keywords

  • liver mortality
  • Hepatitis C
  • injecting drug use
  • health statistics
  • international comparisons

Cite this

@article{8283619ba93a4748bc831e363df365d0,
title = "Liver mortality attributable to chronic hepatitis C virus infection in Denmark and Scotland: using spontaneous resolvers as the benchmark comparator",
abstract = "Liver mortality among individuals with chronic hepatitis C (CHC) infection is common, but the relative contribution of CHC per se versus adverse health behaviors is uncertain. We explored data on spontaneous resolvers of hepatitis C virus (HCV) as a benchmark group to uncover the independent contribution of CHC on liver mortality. Using national HCV diagnosis and mortality registers from Denmark and Scotland, we calculated the liver mortality rate (LMR) for persons diagnosed with CHC infection (LMRchronic) and spontaneously resolved infection (LMRresolved), according to subgroups defined by age, sex, and drug use. Through these mortality rates, we determined subgroup-specific attributable fractions (AFs), defined as (LMRchronic - LMRresolved)/LMRchronic, and then calculated the total attributable fraction (TAF) as a weighted average of these AFs. Thus, the TAF represents the overall fraction (where 0.00 = not attributable at all; and 1.00 = entirely attributable) of liver mortality attributable to CHC in the diagnosed population. Our cohort comprised 7,005 and 21,729 persons diagnosed with HCV antibodies in Denmark and Scotland, respectively. Mean follow-up duration was 6.3-6.9 years. The TAF increased stepwise with age. It was lowest for death occurring at <45 years of age (0.21 in Denmark; 0.26 in Scotland), higher for death occurring at 45-59 years (0.69 in Denmark; 0.69 in Scotland), and highest for death at 60+years (0.92 in Denmark; 0.75 in Scotland). Overall, the TAF was 0.66 (95{\%} confidence interval [CI]: 0.55-0.78) in Denmark and 0.55 (95{\%} CI: 0.44-0.66) in Scotland. Conclusions: In Denmark and Scotland, the majority of liver death in the CHC-diagnosed population can be attributed to CHC—nevertheless, an appreciable fraction cannot, cautioning that liver mortality in this population is a compound problem that can be reduced, but not solved, through antiviral therapy alone.",
keywords = "liver mortality, Hepatitis C, injecting drug use, health statistics, international comparisons",
author = "Hamish Innes and Hutchinson, {Sharon J.} and Niels Obel and Christensen, {Peer B.} and Aspinall, {Esther J.} and David Goldberg and Henrik Krarap and McDonald, {Scott A.} and Allan McLeod and Amanda Weir and Omland, {Lars. H.}",
note = "Acceptance from webpage",
year = "2016",
month = "5",
doi = "10.1002/hep.28458",
language = "English",
volume = "63",
pages = "1506--1516",
journal = "Hepatology",
issn = "0270-9139",
publisher = "John Wiley and Sons Ltd",
number = "5",

}

Liver mortality attributable to chronic hepatitis C virus infection in Denmark and Scotland: using spontaneous resolvers as the benchmark comparator. / Innes, Hamish; Hutchinson, Sharon J.; Obel, Niels; Christensen, Peer B.; Aspinall, Esther J.; Goldberg, David; Krarap, Henrik; McDonald, Scott A.; McLeod, Allan; Weir, Amanda; Omland, Lars. H.

In: Hepatology, Vol. 63, No. 5, 05.2016, p. 1506-1516.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Liver mortality attributable to chronic hepatitis C virus infection in Denmark and Scotland: using spontaneous resolvers as the benchmark comparator

AU - Innes, Hamish

AU - Hutchinson, Sharon J.

AU - Obel, Niels

AU - Christensen, Peer B.

AU - Aspinall, Esther J.

AU - Goldberg, David

AU - Krarap, Henrik

AU - McDonald, Scott A.

AU - McLeod, Allan

AU - Weir, Amanda

AU - Omland, Lars. H.

N1 - Acceptance from webpage

PY - 2016/5

Y1 - 2016/5

N2 - Liver mortality among individuals with chronic hepatitis C (CHC) infection is common, but the relative contribution of CHC per se versus adverse health behaviors is uncertain. We explored data on spontaneous resolvers of hepatitis C virus (HCV) as a benchmark group to uncover the independent contribution of CHC on liver mortality. Using national HCV diagnosis and mortality registers from Denmark and Scotland, we calculated the liver mortality rate (LMR) for persons diagnosed with CHC infection (LMRchronic) and spontaneously resolved infection (LMRresolved), according to subgroups defined by age, sex, and drug use. Through these mortality rates, we determined subgroup-specific attributable fractions (AFs), defined as (LMRchronic - LMRresolved)/LMRchronic, and then calculated the total attributable fraction (TAF) as a weighted average of these AFs. Thus, the TAF represents the overall fraction (where 0.00 = not attributable at all; and 1.00 = entirely attributable) of liver mortality attributable to CHC in the diagnosed population. Our cohort comprised 7,005 and 21,729 persons diagnosed with HCV antibodies in Denmark and Scotland, respectively. Mean follow-up duration was 6.3-6.9 years. The TAF increased stepwise with age. It was lowest for death occurring at <45 years of age (0.21 in Denmark; 0.26 in Scotland), higher for death occurring at 45-59 years (0.69 in Denmark; 0.69 in Scotland), and highest for death at 60+years (0.92 in Denmark; 0.75 in Scotland). Overall, the TAF was 0.66 (95% confidence interval [CI]: 0.55-0.78) in Denmark and 0.55 (95% CI: 0.44-0.66) in Scotland. Conclusions: In Denmark and Scotland, the majority of liver death in the CHC-diagnosed population can be attributed to CHC—nevertheless, an appreciable fraction cannot, cautioning that liver mortality in this population is a compound problem that can be reduced, but not solved, through antiviral therapy alone.

AB - Liver mortality among individuals with chronic hepatitis C (CHC) infection is common, but the relative contribution of CHC per se versus adverse health behaviors is uncertain. We explored data on spontaneous resolvers of hepatitis C virus (HCV) as a benchmark group to uncover the independent contribution of CHC on liver mortality. Using national HCV diagnosis and mortality registers from Denmark and Scotland, we calculated the liver mortality rate (LMR) for persons diagnosed with CHC infection (LMRchronic) and spontaneously resolved infection (LMRresolved), according to subgroups defined by age, sex, and drug use. Through these mortality rates, we determined subgroup-specific attributable fractions (AFs), defined as (LMRchronic - LMRresolved)/LMRchronic, and then calculated the total attributable fraction (TAF) as a weighted average of these AFs. Thus, the TAF represents the overall fraction (where 0.00 = not attributable at all; and 1.00 = entirely attributable) of liver mortality attributable to CHC in the diagnosed population. Our cohort comprised 7,005 and 21,729 persons diagnosed with HCV antibodies in Denmark and Scotland, respectively. Mean follow-up duration was 6.3-6.9 years. The TAF increased stepwise with age. It was lowest for death occurring at <45 years of age (0.21 in Denmark; 0.26 in Scotland), higher for death occurring at 45-59 years (0.69 in Denmark; 0.69 in Scotland), and highest for death at 60+years (0.92 in Denmark; 0.75 in Scotland). Overall, the TAF was 0.66 (95% confidence interval [CI]: 0.55-0.78) in Denmark and 0.55 (95% CI: 0.44-0.66) in Scotland. Conclusions: In Denmark and Scotland, the majority of liver death in the CHC-diagnosed population can be attributed to CHC—nevertheless, an appreciable fraction cannot, cautioning that liver mortality in this population is a compound problem that can be reduced, but not solved, through antiviral therapy alone.

KW - liver mortality

KW - Hepatitis C

KW - injecting drug use

KW - health statistics

KW - international comparisons

U2 - 10.1002/hep.28458

DO - 10.1002/hep.28458

M3 - Article

VL - 63

SP - 1506

EP - 1516

JO - Hepatology

JF - Hepatology

SN - 0270-9139

IS - 5

ER -