Mortality in hepatitis C patients who achieve a sustained viral response compared to the general population

Hamish Innes, Scott McDonald, Peter Hayes, John F. Dillon, Sam Allen, David Goldberg, Peter R. Mills, Stephen T. Barclay, David Wilks, Heather Valerio, Ray Fox, Diptendu Bhattacharyya, Nicholas Kennedy, Judith Morris, Andrew Fraser, Adrian Stanley, Peter Bramley, Sharon J. Hutchinson

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Abstract

Background & Aims The number of people living with previous hepatitis C infection that have attained a sustained viral response (SVR) is expected to grow rapidly. So far, the prognosis of this group relative to the general population is unclear. Methods Individuals attaining SVR in Scotland in 1996–2011 were identified using a national database. Through record-linkage, we obtained cause-specific mortality data complete to Dec 2013. We calculated standardised mortality ratios (SMRs) to compare the frequency of mortality in SVR patients to the general population. In a parallel analysis, we used Cox regression to identify modifiable patient characteristics associated with post-SVR mortality. Results We identified 1824 patients, followed on average for 5.2 years after SVR. In total, 78 deaths were observed. Overall, all-cause mortality was 1.9 times more frequent for SVR patients than the general population (SMR: 1.86; 95% confidence interval (CI): 1.49–2.32). Significant cause-specific elevations were seen for death due to primary liver cancer (SMR: 23.50; 95% CI: 12.23–45.16), and death due to drug-related causes (SMR: 6.58, 95% CI: 4.15–10.45). Together these two causes accounted for 66% of the total excess death observed. All of the modifiable characteristics associated with increased mortality were markers either of heavy alcohol use or injecting drug use. Individuals without these behavioural markers (32.8% of cohort) experienced equivalent survival to the general population (SMR: 0.70; 95% CI: 0.41–1.18) Conclusions Mortality in Scottish SVR patients is higher overall than the general population. The excess was driven by death from drug-related causes and liver cancer. Health risk behaviours emerged as important modifiable determinants of mortality in this population.
Original languageEnglish
Pages (from-to)19-27
Number of pages9
JournalJournal of Hepatology
Volume66
Issue number1
Early online date18 Aug 2016
DOIs
Publication statusPublished - Jan 2017

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Hepatitis C
Mortality
Population
Confidence Intervals
Liver Neoplasms
Pharmaceutical Preparations
Scotland
Risk-Taking
Alcohols
Databases
Survival

Keywords

  • hepatitis C
  • sustained viral response
  • excess mortality
  • cure
  • epidemiology

Cite this

Innes, Hamish ; McDonald, Scott ; Hayes, Peter ; Dillon, John F. ; Allen, Sam ; Goldberg, David ; Mills, Peter R. ; Barclay, Stephen T. ; Wilks, David ; Valerio, Heather ; Fox, Ray ; Bhattacharyya, Diptendu ; Kennedy, Nicholas ; Morris, Judith ; Fraser, Andrew ; Stanley, Adrian ; Bramley, Peter ; Hutchinson, Sharon J. / Mortality in hepatitis C patients who achieve a sustained viral response compared to the general population. In: Journal of Hepatology. 2017 ; Vol. 66, No. 1. pp. 19-27.
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abstract = "Background & Aims The number of people living with previous hepatitis C infection that have attained a sustained viral response (SVR) is expected to grow rapidly. So far, the prognosis of this group relative to the general population is unclear. Methods Individuals attaining SVR in Scotland in 1996–2011 were identified using a national database. Through record-linkage, we obtained cause-specific mortality data complete to Dec 2013. We calculated standardised mortality ratios (SMRs) to compare the frequency of mortality in SVR patients to the general population. In a parallel analysis, we used Cox regression to identify modifiable patient characteristics associated with post-SVR mortality. Results We identified 1824 patients, followed on average for 5.2 years after SVR. In total, 78 deaths were observed. Overall, all-cause mortality was 1.9 times more frequent for SVR patients than the general population (SMR: 1.86; 95{\%} confidence interval (CI): 1.49–2.32). Significant cause-specific elevations were seen for death due to primary liver cancer (SMR: 23.50; 95{\%} CI: 12.23–45.16), and death due to drug-related causes (SMR: 6.58, 95{\%} CI: 4.15–10.45). Together these two causes accounted for 66{\%} of the total excess death observed. All of the modifiable characteristics associated with increased mortality were markers either of heavy alcohol use or injecting drug use. Individuals without these behavioural markers (32.8{\%} of cohort) experienced equivalent survival to the general population (SMR: 0.70; 95{\%} CI: 0.41–1.18) Conclusions Mortality in Scottish SVR patients is higher overall than the general population. The excess was driven by death from drug-related causes and liver cancer. Health risk behaviours emerged as important modifiable determinants of mortality in this population.",
keywords = "hepatitis C, sustained viral response, excess mortality, cure, epidemiology",
author = "Hamish Innes and Scott McDonald and Peter Hayes and Dillon, {John F.} and Sam Allen and David Goldberg and Mills, {Peter R.} and Barclay, {Stephen T.} and David Wilks and Heather Valerio and Ray Fox and Diptendu Bhattacharyya and Nicholas Kennedy and Judith Morris and Andrew Fraser and Adrian Stanley and Peter Bramley and Hutchinson, {Sharon J.}",
note = "Accepted: 05/08/2016 (in SAN) Online pub: 18/08/2016 AAM: uploaded 17/10/16; 12m embargo required Check back for print pub details",
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Innes, H, McDonald, S, Hayes, P, Dillon, JF, Allen, S, Goldberg, D, Mills, PR, Barclay, ST, Wilks, D, Valerio, H, Fox, R, Bhattacharyya, D, Kennedy, N, Morris, J, Fraser, A, Stanley, A, Bramley, P & Hutchinson, SJ 2017, 'Mortality in hepatitis C patients who achieve a sustained viral response compared to the general population', Journal of Hepatology, vol. 66, no. 1, pp. 19-27. https://doi.org/10.1016/j.jhep.2016.08.004

Mortality in hepatitis C patients who achieve a sustained viral response compared to the general population. / Innes, Hamish; McDonald, Scott; Hayes, Peter; Dillon, John F.; Allen, Sam; Goldberg, David; Mills, Peter R.; Barclay, Stephen T.; Wilks, David; Valerio, Heather; Fox, Ray; Bhattacharyya, Diptendu ; Kennedy, Nicholas; Morris, Judith; Fraser, Andrew; Stanley, Adrian; Bramley, Peter ; Hutchinson, Sharon J.

In: Journal of Hepatology, Vol. 66, No. 1, 01.2017, p. 19-27.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Mortality in hepatitis C patients who achieve a sustained viral response compared to the general population

AU - Innes, Hamish

AU - McDonald, Scott

AU - Hayes, Peter

AU - Dillon, John F.

AU - Allen, Sam

AU - Goldberg, David

AU - Mills, Peter R.

AU - Barclay, Stephen T.

AU - Wilks, David

AU - Valerio, Heather

AU - Fox, Ray

AU - Bhattacharyya, Diptendu

AU - Kennedy, Nicholas

AU - Morris, Judith

AU - Fraser, Andrew

AU - Stanley, Adrian

AU - Bramley, Peter

AU - Hutchinson, Sharon J.

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PY - 2017/1

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N2 - Background & Aims The number of people living with previous hepatitis C infection that have attained a sustained viral response (SVR) is expected to grow rapidly. So far, the prognosis of this group relative to the general population is unclear. Methods Individuals attaining SVR in Scotland in 1996–2011 were identified using a national database. Through record-linkage, we obtained cause-specific mortality data complete to Dec 2013. We calculated standardised mortality ratios (SMRs) to compare the frequency of mortality in SVR patients to the general population. In a parallel analysis, we used Cox regression to identify modifiable patient characteristics associated with post-SVR mortality. Results We identified 1824 patients, followed on average for 5.2 years after SVR. In total, 78 deaths were observed. Overall, all-cause mortality was 1.9 times more frequent for SVR patients than the general population (SMR: 1.86; 95% confidence interval (CI): 1.49–2.32). Significant cause-specific elevations were seen for death due to primary liver cancer (SMR: 23.50; 95% CI: 12.23–45.16), and death due to drug-related causes (SMR: 6.58, 95% CI: 4.15–10.45). Together these two causes accounted for 66% of the total excess death observed. All of the modifiable characteristics associated with increased mortality were markers either of heavy alcohol use or injecting drug use. Individuals without these behavioural markers (32.8% of cohort) experienced equivalent survival to the general population (SMR: 0.70; 95% CI: 0.41–1.18) Conclusions Mortality in Scottish SVR patients is higher overall than the general population. The excess was driven by death from drug-related causes and liver cancer. Health risk behaviours emerged as important modifiable determinants of mortality in this population.

AB - Background & Aims The number of people living with previous hepatitis C infection that have attained a sustained viral response (SVR) is expected to grow rapidly. So far, the prognosis of this group relative to the general population is unclear. Methods Individuals attaining SVR in Scotland in 1996–2011 were identified using a national database. Through record-linkage, we obtained cause-specific mortality data complete to Dec 2013. We calculated standardised mortality ratios (SMRs) to compare the frequency of mortality in SVR patients to the general population. In a parallel analysis, we used Cox regression to identify modifiable patient characteristics associated with post-SVR mortality. Results We identified 1824 patients, followed on average for 5.2 years after SVR. In total, 78 deaths were observed. Overall, all-cause mortality was 1.9 times more frequent for SVR patients than the general population (SMR: 1.86; 95% confidence interval (CI): 1.49–2.32). Significant cause-specific elevations were seen for death due to primary liver cancer (SMR: 23.50; 95% CI: 12.23–45.16), and death due to drug-related causes (SMR: 6.58, 95% CI: 4.15–10.45). Together these two causes accounted for 66% of the total excess death observed. All of the modifiable characteristics associated with increased mortality were markers either of heavy alcohol use or injecting drug use. Individuals without these behavioural markers (32.8% of cohort) experienced equivalent survival to the general population (SMR: 0.70; 95% CI: 0.41–1.18) Conclusions Mortality in Scottish SVR patients is higher overall than the general population. The excess was driven by death from drug-related causes and liver cancer. Health risk behaviours emerged as important modifiable determinants of mortality in this population.

KW - hepatitis C

KW - sustained viral response

KW - excess mortality

KW - cure

KW - epidemiology

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DO - 10.1016/j.jhep.2016.08.004

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