The contribution of alcohol-use disorder to decompensated cirrhosis among people with hepatitis C: an international comparison study

Maryam Alavi, Naveed Z. Janjua, Mei Chong, Jason Grebely, Esther J. Aspinall, Hamish Innes, Heather M. Valerio, Behzad Hajarizadeh, Peter C. Hayes, Mel Krajden, Janaki Amin, Matthew G. Law, Jacob George, David J. Goldberg, Sharon J. Hutchinson, Gregory J. Dore

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Abstract

Background and aims: The advent of direct-acting antivirals (DAAs) has led to ambitious targets for hepatitis C virus (HCV) elimination. However, in the context of alcohol use disorder the ability of DAAs to achieve these targets may be compromised. The aim of this study was to evaluate the contribution of alcohol use disorder to HCV-related decompensated cirrhosis in three settings.
Methods: HCV notifications from British Columbia (BC), Canada, New South Wales (NSW), Australia, and Scotland (1995-2011/2012/2013, respectively) were linked to hospital admissions (2001-2012/2013/2014, respectively). Alcohol-use disorder was defined by non-liver-related hospitalisation due to alcohol use. Age-standardised decompensated cirrhosis incidence rates were plotted, associated factors were assessed using Cox regression, and alcohol-use disorder-associated population attributable fractions (PAFs) were computed. Results: Among 58,487, 84,529, and 31,924 people with HCV in BC, NSW, and Scotland, 2,689 (4.6%), 3,169 (3.7%), and 1,375 (4.3%) had a decompensated cirrhosis diagnosis, and 28%, 32%, and 50% of those with decompensated cirrhosis had alcohol-use disorder, respectively. Age-standardised decompensated cirrhosis incidence rates were considerably higher among people with alcohol-use disorder in NSW and Scotland. Decompensated cirrhosis was independently associated with alcohol-use disorder in BC, aHR 1.92, 95% CI 1.76, 2.10; NSW, aHR 3.68, 95% CI 3.38, 4.00, and; Scotland, aHR 3.88, 95% CI 3.42, 4.40. The PAFs of decompensated cirrhosis-related to alcohol-use disorder were 13%, 25%, and 40% in BC, NSW, and Scotland, respectively.
Conclusions: Alcohol-use disorder was a major contributor to HCV liver disease burden in all settings, more distinctly in Scotland. The extent to which alcohol use would compromise the individual and population level benefits of direct-acting antiviral therapy (DAA) needs to be closely monitored. Countries, where appropriate, must develop strategies combining DAA treatment uptake promotion and alcohol-use disorder management, if World Health Organization 2030 HCV mortality reduction targets are to be achieved.
Original languageEnglish
Pages (from-to)393-401
Number of pages9
JournalJournal of Hepatology
Volume68
Issue number3
Early online date26 Oct 2017
DOIs
Publication statusPublished - Mar 2018

Fingerprint

Hepatitis C
Fibrosis
Alcohols
Scotland
New South Wales
Hepacivirus
British Columbia
Antiviral Agents
Population
South Australia
Incidence
Virus Diseases
Canada
Liver Diseases
Hospitalization

Keywords

  • alcohol
  • cirrhosis
  • hepatitis C
  • virology
  • HCV
  • liver disease
  • alcohol use disorder
  • population-based
  • data linkage

Cite this

Alavi, Maryam ; Janjua, Naveed Z. ; Chong, Mei ; Grebely, Jason ; Aspinall, Esther J. ; Innes, Hamish ; Valerio, Heather M. ; Hajarizadeh, Behzad ; Hayes, Peter C. ; Krajden, Mel ; Amin, Janaki ; Law, Matthew G. ; George, Jacob ; Goldberg, David J. ; Hutchinson, Sharon J. ; Dore, Gregory J. / The contribution of alcohol-use disorder to decompensated cirrhosis among people with hepatitis C: an international comparison study. In: Journal of Hepatology. 2018 ; Vol. 68, No. 3. pp. 393-401.
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abstract = "Background and aims: The advent of direct-acting antivirals (DAAs) has led to ambitious targets for hepatitis C virus (HCV) elimination. However, in the context of alcohol use disorder the ability of DAAs to achieve these targets may be compromised. The aim of this study was to evaluate the contribution of alcohol use disorder to HCV-related decompensated cirrhosis in three settings.Methods: HCV notifications from British Columbia (BC), Canada, New South Wales (NSW), Australia, and Scotland (1995-2011/2012/2013, respectively) were linked to hospital admissions (2001-2012/2013/2014, respectively). Alcohol-use disorder was defined by non-liver-related hospitalisation due to alcohol use. Age-standardised decompensated cirrhosis incidence rates were plotted, associated factors were assessed using Cox regression, and alcohol-use disorder-associated population attributable fractions (PAFs) were computed. Results: Among 58,487, 84,529, and 31,924 people with HCV in BC, NSW, and Scotland, 2,689 (4.6{\%}), 3,169 (3.7{\%}), and 1,375 (4.3{\%}) had a decompensated cirrhosis diagnosis, and 28{\%}, 32{\%}, and 50{\%} of those with decompensated cirrhosis had alcohol-use disorder, respectively. Age-standardised decompensated cirrhosis incidence rates were considerably higher among people with alcohol-use disorder in NSW and Scotland. Decompensated cirrhosis was independently associated with alcohol-use disorder in BC, aHR 1.92, 95{\%} CI 1.76, 2.10; NSW, aHR 3.68, 95{\%} CI 3.38, 4.00, and; Scotland, aHR 3.88, 95{\%} CI 3.42, 4.40. The PAFs of decompensated cirrhosis-related to alcohol-use disorder were 13{\%}, 25{\%}, and 40{\%} in BC, NSW, and Scotland, respectively.Conclusions: Alcohol-use disorder was a major contributor to HCV liver disease burden in all settings, more distinctly in Scotland. The extent to which alcohol use would compromise the individual and population level benefits of direct-acting antiviral therapy (DAA) needs to be closely monitored. Countries, where appropriate, must develop strategies combining DAA treatment uptake promotion and alcohol-use disorder management, if World Health Organization 2030 HCV mortality reduction targets are to be achieved.",
keywords = "alcohol, cirrhosis, hepatitis C, virology, HCV, liver disease, alcohol use disorder, population-based, data linkage",
author = "Maryam Alavi and Janjua, {Naveed Z.} and Mei Chong and Jason Grebely and Aspinall, {Esther J.} and Hamish Innes and Valerio, {Heather M.} and Behzad Hajarizadeh and Hayes, {Peter C.} and Mel Krajden and Janaki Amin and Law, {Matthew G.} and Jacob George and Goldberg, {David J.} and Hutchinson, {Sharon J.} and Dore, {Gregory J.}",
note = "Acceptance email in SAN AAM: 12m embargo Client org. holds copyright ET 8-1-18",
year = "2018",
month = "3",
doi = "10.1016/j.jhep.2017.10.019",
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Alavi, M, Janjua, NZ, Chong, M, Grebely, J, Aspinall, EJ, Innes, H, Valerio, HM, Hajarizadeh, B, Hayes, PC, Krajden, M, Amin, J, Law, MG, George, J, Goldberg, DJ, Hutchinson, SJ & Dore, GJ 2018, 'The contribution of alcohol-use disorder to decompensated cirrhosis among people with hepatitis C: an international comparison study', Journal of Hepatology, vol. 68, no. 3, pp. 393-401. https://doi.org/10.1016/j.jhep.2017.10.019

The contribution of alcohol-use disorder to decompensated cirrhosis among people with hepatitis C: an international comparison study. / Alavi, Maryam ; Janjua, Naveed Z. ; Chong, Mei; Grebely, Jason; Aspinall, Esther J.; Innes, Hamish; Valerio, Heather M.; Hajarizadeh, Behzad ; Hayes, Peter C.; Krajden, Mel; Amin, Janaki; Law, Matthew G.; George, Jacob; Goldberg, David J.; Hutchinson, Sharon J.; Dore, Gregory J.

In: Journal of Hepatology, Vol. 68, No. 3, 03.2018, p. 393-401.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The contribution of alcohol-use disorder to decompensated cirrhosis among people with hepatitis C: an international comparison study

AU - Alavi, Maryam

AU - Janjua, Naveed Z.

AU - Chong, Mei

AU - Grebely, Jason

AU - Aspinall, Esther J.

AU - Innes, Hamish

AU - Valerio, Heather M.

AU - Hajarizadeh, Behzad

AU - Hayes, Peter C.

AU - Krajden, Mel

AU - Amin, Janaki

AU - Law, Matthew G.

AU - George, Jacob

AU - Goldberg, David J.

AU - Hutchinson, Sharon J.

AU - Dore, Gregory J.

N1 - Acceptance email in SAN AAM: 12m embargo Client org. holds copyright ET 8-1-18

PY - 2018/3

Y1 - 2018/3

N2 - Background and aims: The advent of direct-acting antivirals (DAAs) has led to ambitious targets for hepatitis C virus (HCV) elimination. However, in the context of alcohol use disorder the ability of DAAs to achieve these targets may be compromised. The aim of this study was to evaluate the contribution of alcohol use disorder to HCV-related decompensated cirrhosis in three settings.Methods: HCV notifications from British Columbia (BC), Canada, New South Wales (NSW), Australia, and Scotland (1995-2011/2012/2013, respectively) were linked to hospital admissions (2001-2012/2013/2014, respectively). Alcohol-use disorder was defined by non-liver-related hospitalisation due to alcohol use. Age-standardised decompensated cirrhosis incidence rates were plotted, associated factors were assessed using Cox regression, and alcohol-use disorder-associated population attributable fractions (PAFs) were computed. Results: Among 58,487, 84,529, and 31,924 people with HCV in BC, NSW, and Scotland, 2,689 (4.6%), 3,169 (3.7%), and 1,375 (4.3%) had a decompensated cirrhosis diagnosis, and 28%, 32%, and 50% of those with decompensated cirrhosis had alcohol-use disorder, respectively. Age-standardised decompensated cirrhosis incidence rates were considerably higher among people with alcohol-use disorder in NSW and Scotland. Decompensated cirrhosis was independently associated with alcohol-use disorder in BC, aHR 1.92, 95% CI 1.76, 2.10; NSW, aHR 3.68, 95% CI 3.38, 4.00, and; Scotland, aHR 3.88, 95% CI 3.42, 4.40. The PAFs of decompensated cirrhosis-related to alcohol-use disorder were 13%, 25%, and 40% in BC, NSW, and Scotland, respectively.Conclusions: Alcohol-use disorder was a major contributor to HCV liver disease burden in all settings, more distinctly in Scotland. The extent to which alcohol use would compromise the individual and population level benefits of direct-acting antiviral therapy (DAA) needs to be closely monitored. Countries, where appropriate, must develop strategies combining DAA treatment uptake promotion and alcohol-use disorder management, if World Health Organization 2030 HCV mortality reduction targets are to be achieved.

AB - Background and aims: The advent of direct-acting antivirals (DAAs) has led to ambitious targets for hepatitis C virus (HCV) elimination. However, in the context of alcohol use disorder the ability of DAAs to achieve these targets may be compromised. The aim of this study was to evaluate the contribution of alcohol use disorder to HCV-related decompensated cirrhosis in three settings.Methods: HCV notifications from British Columbia (BC), Canada, New South Wales (NSW), Australia, and Scotland (1995-2011/2012/2013, respectively) were linked to hospital admissions (2001-2012/2013/2014, respectively). Alcohol-use disorder was defined by non-liver-related hospitalisation due to alcohol use. Age-standardised decompensated cirrhosis incidence rates were plotted, associated factors were assessed using Cox regression, and alcohol-use disorder-associated population attributable fractions (PAFs) were computed. Results: Among 58,487, 84,529, and 31,924 people with HCV in BC, NSW, and Scotland, 2,689 (4.6%), 3,169 (3.7%), and 1,375 (4.3%) had a decompensated cirrhosis diagnosis, and 28%, 32%, and 50% of those with decompensated cirrhosis had alcohol-use disorder, respectively. Age-standardised decompensated cirrhosis incidence rates were considerably higher among people with alcohol-use disorder in NSW and Scotland. Decompensated cirrhosis was independently associated with alcohol-use disorder in BC, aHR 1.92, 95% CI 1.76, 2.10; NSW, aHR 3.68, 95% CI 3.38, 4.00, and; Scotland, aHR 3.88, 95% CI 3.42, 4.40. The PAFs of decompensated cirrhosis-related to alcohol-use disorder were 13%, 25%, and 40% in BC, NSW, and Scotland, respectively.Conclusions: Alcohol-use disorder was a major contributor to HCV liver disease burden in all settings, more distinctly in Scotland. The extent to which alcohol use would compromise the individual and population level benefits of direct-acting antiviral therapy (DAA) needs to be closely monitored. Countries, where appropriate, must develop strategies combining DAA treatment uptake promotion and alcohol-use disorder management, if World Health Organization 2030 HCV mortality reduction targets are to be achieved.

KW - alcohol

KW - cirrhosis

KW - hepatitis C

KW - virology

KW - HCV

KW - liver disease

KW - alcohol use disorder

KW - population-based

KW - data linkage

U2 - 10.1016/j.jhep.2017.10.019

DO - 10.1016/j.jhep.2017.10.019

M3 - Article

VL - 68

SP - 393

EP - 401

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