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Cause of death in individuals with chronic HBV and/or HCV infection, a nationwide community-based register study
Örebro University, School of Health and Medical Sciences.ORCID iD: 0000-0001-7248-0910
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2008 (English)In: Journal of Viral Hepatitis, ISSN 1352-0504, E-ISSN 1365-2893, Vol. 15, no 7, p. 538-550Article in journal (Refereed) Published
Abstract [en]

Studies on chronic viral hepatitis and mortality have often been made on selected populations or in high-endemic countries. The aim of this study was to investigate the causes of death and the mortality rates in the nationwide cohorts of people chronically infected with hepatitis B virus (HBV) and/or hepatitis C virus (HCV) in Sweden, a low-endemic country. All notifications on chronic HBV infection and HCV infection 1990-2003 were linked to the Cause of Death Register. A total of 9517 people with chronic HBV infection, 34 235 people with HCV infection and 1601 with chronic HBV-HCV co-infection were included, and the mean observation times were 6.4, 6.3 and 7.9 years, respectively. The mortality in the cohorts was compared with age- and gender-specific mortality in the general population and standardized mortality ratios (SMR) were calculated. All-cause mortality was significantly increased, SMR 2.3 (HBV), 5.8 (HCV) and 8.5 (HBV-HCV), with a great excess liver-related mortality in all cohorts, SMR 21.7, 35.5 and 46.2, respectively. In HCV and HBV-HCV infected there was an increased mortality due to drug-related psychiatric diagnoses (SMR: 20.7 and 27.6) and external causes (SMR: 12.4 and 11.4), predominantly at younger age. To conclude, this study demonstrated an increased all-cause mortality, with a great excess mortality from liver disease, in all cohorts. In people with HCV infection the highest excess mortality in younger ages was from drug-related and external reasons.

PMID: 18397223 [PubMed - indexed for MEDLINE]

Place, publisher, year, edition, pages
2008. Vol. 15, no 7, p. 538-550
Keywords [en]
Carcinoma; Hepatocellular/*mortality, Cohort Studies, Female, Hepatitis B; Chronic/epidemiology/*mortality, Hepatitis C; Chronic/epidemiology/*mortality, Humans, Liver Neoplasms/etiology/*mortality, Male, Medical Record Linkage, Population Surveillance/methods, Registries
National Category
Medical and Health Sciences Infectious Medicine
Research subject
Infectious Diseases
Identifiers
URN: urn:nbn:se:oru:diva-4744DOI: 10.1111/j.1365-2893.2008.00982.xPubMedID: 18397223OAI: oai:DiVA.org:oru-4744DiVA, id: diva2:139043
Note
Part of thesis: http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-7835Available from: 2008-11-24 Created: 2008-11-24 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Hepatitis C virus infection: a nationwide study of associated morbidity and mortality
Open this publication in new window or tab >>Hepatitis C virus infection: a nationwide study of associated morbidity and mortality
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The hepatitis C virus (HCV) was characterised in 1989. HCV was transmitted through transfusion of blood/blood products, but injection drug use is now the most common route of transmission. The infection is usually asymptomatic but becomes chronic in about 75%, and in 20 years 15-25% develops liver cirrhosis, with a risk for liver failure and liver cancer. HCV has also been associated with lymphoproliferative disorders. The aim of this thesis was to study morbidity and mortality in a national, population-based cohort of HCV-infected individuals. The study population consisted of all persons with a diagnosed HCV-infection recorded in the national surveillance database. This file was linked to other national registers to obtain information of emigration, deaths, cancers, and inpatient care. All personal identifiers were removed before analysis.

In Paper I the standardized incidence ratios (SIR) for Hodgkin’s and non-Hodgkin’s lymphoma (NHL), multiple myeloma, acute and chronic lymphatic leukaemia, and thyroid cancer were studied. In the HCV-cohort (n: 27,150) there was a doubled risk for NHL and multiple myeloma in patients infected for more than 15 years, compared with the general population (age-, sex- and calendar-year specific incidence rates). The results strengthened these earlier controversial associations.

The SIR and also the absolute risk for primary liver cancer were estimated in Paper II. In the HCV-cohort (n: 36,126) the individuals infected for more than 25 years had a more than 40 times increased risk for liver cancer compared with the general population. The absolute risk of primary liver cancer was 7% within 40 years of HCV-infection.

Mortality and cause of death were studied in Paper III. The standardized mortality ratio (SMR) demonstrated a 5.8 times excess mortality in the HCV-cohort (n: 34,235) compared with the general population, and a 35.5 times excess mortality from liver disease. Deaths from illicit drugs and external reasons were common in young adults.

Paper IV presents a study of inpatient care. The HCV-cohort (n: 43,000) was compared with a matched reference population (n: 215,000). Cox regression was used to estimate the likelihood, a hazard ratio, for admission to hospital, and frequencies and rates to estimate the total burden. In the HCV-cohort inpatient care was high and about 50% was psychiatric, often drug-related care. The likelihood for liver-related admissions was very high, and serious liver complications increased in the 2000s, indicating that HCV-associated liver disease will increase the next decade. In the 2000s, about 1000 individuals per year were treated with HCV-combination therapy.

To conclude, the risk for NHL and multiple myeloma was doubled, and liver- and drug-related morbidity and mortality was very high in the HCV-cohort. Serious liver complications increased in the 2000s and will probably increase the coming decade.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2009. p. 66
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 34
Keywords
HCV, hepatitis C, epidemiology, non-Hodgkin's lymphoma, NHL, multiple myeloma, primary liver cancer, HCC, mortality, inpatient care, hospitalization
National Category
Medical and Health Sciences
Research subject
Infectious Diseases; Epidemiology; Medicine
Identifiers
urn:nbn:se:oru:diva-7835 (URN)978-91-7668-681-2 (ISBN)
Public defence
2009-10-09, Wilandersalen, Universitetssjukhuset, Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2009-09-14 Created: 2009-09-07 Last updated: 2017-10-18Bibliographically approved

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Publisher's full textPubMedhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&list_uids=18397223&dopt=Citation

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Duberg, Ann-SofiBäck, Erik

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