Trends in mortality after diagnosis of hepatitis C virus infection: an international comparison and implications for monitoring the population impact of treatment

Esther J. Aspinall*, Sharon J. Hutchinson, Naveed Z. Janjua, Jason Grebely, Amanda Yu, Maryam Alavi, Janaki Amin, David J. Goldberg, Hamish Innes, Matthew Law, Scott R. Walter, Mel Krajden, Gregory J. Dore

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Background & Aims
People living with hepatitis C virus (HCV) are at increased risk of all-cause and liver-related mortality, although successful treatment has been shown to reduce this risk. The aim of this study was to provide baseline data on trends in cause-specific mortality and to establish an international surveillance system for evaluating the population level impact of HCV treatments.

Methods
Population level HCV diagnosis databases from Scotland (1997–2010), Australia (New South Wales [NSW]) (1997–2006), and Canada (British Columbia [BC]) (1997–2003) were linked to corresponding death registries using record linkage. For each region, age-adjusted cause-specific mortality rates were calculated, and trends in annual age-adjusted liver-related mortality were plotted.

Results
Of 105,138 individuals diagnosed with HCV (21,810 in Scotland, 58,484 in NSW, and 24,844 in BC), there were 7275 deaths (2572 in Scotland, 2655 in NSW, and 2048 in BC). Liver-related deaths accounted for 26% of deaths in Scotland, 21% in NSW, and 22% in BC. Temporal trends in age-adjusted liver related mortality were stable in Scotland (males p = 0.4; females p = 0.2) and NSW (males p = 0.9; females p = 0.9), while there was an increase in BC (males p = 0.002; females p = 0.04).

Conclusions

The risk of liver-related mortality after a diagnosis of HCV has remained stable or increased over time across three regions with well-established diagnosis databases, highlighting that HCV treatment programmes to-date have had minimal impact on population level HCV-related liver disease. With more effective therapies on the horizon, and greater uptake of treatment anticipated, the potential of future therapeutic strategies to reduce HCV-related mortality is considerable.
Original languageEnglish
Pages (from-to)269-277
Number of pages9
JournalJournal of Hepatology
Volume62
Issue number2
Early online date6 Sep 2014
DOIs
Publication statusPublished - Feb 2015

Keywords

  • hepatitis C diagnosis
  • liver mortality
  • hepatitis C treatment

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