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.
- hepatitis C
- liver disease
- alcohol use disorder
- data linkage