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Abstract

Background

Monitoring trends in mortality for individuals diagnosed with hepatitis C virus (HCV) infection are important as we expand treatment and move towards World Health Organization elimination targets.

Aim

To estimate mortality rates for individuals aged ≥ 15 years diagnosed with HCV infection in England 2008–16.

Methods

An observational cohort study whereby death certificate information was linked to the Sentinel Surveillance of Blood Borne Virus Testing in England. Age-sex standardised mortality rates (ASMR) for individuals diagnosed with HCV infection (2008–16) were calculated and compared to the general population.

Results

Of 43,895 individuals with HCV infection, 2,656 (6.3%) died. All-cause ASMRs were 2,834.2 per 100,000 person years (PY), 2.3 times higher than in the general population. In individuals aged 30–69 years, all-cause mortality rates were 1,768.9 per 100,000 PY among individuals with HCV, 4.7 times higher than in the general population. ASMRs had not decreased between 2010 (2,992) and 2016 (2,340; p=0.10), with no change from 2014 (p = 0.058). ASMRs were 441.0 times higher for hepatitis, 34.4 times higher for liver cancer, 8.1 times higher for end stage liver disease and 6.4 times higher for external causes than in the general population.

Conclusions

Mortality was higher in individuals with diagnosed HCV infection compared to the general population, highlighting health inequalities. There is a need to improve HCV diagnosis, engagement in care and treatment rates. The high mortality from external causes highlights the importance of integrated health and social care strategies and addressing the needs of this vulnerable population.

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/content/10.2807/1560-7917.ES.2019.24.30.1800695
2019-07-25
2019-10-19
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2019.24.30.1800695
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References

  1. Public Health England (PHE). Hepatitis C in England, 2018 report- Working to eliminate hepatitis C as a major public health threat. 2018. London: PHE; 2018. [accessed Dec 2018]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/798270/HCV_in-England_2019.pdf
  2. Public Health England (PHE). Hepatitis C in the UK- 2015 report. 2015. London: PHE; 2015. [accessed Dec 2018]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/448710/NEW_FINAL_HCV_2015_IN_THE_UK_REPORT_28072015_v2.pdf
  3. Thompson AJ, Holmes JA. Treating hepatitis C - what’s new? Aust Prescr. 2015;38(6):191-7.  https://doi.org/10.18773/austprescr.2015.068  PMID: 26843711 
  4. Singal AG, Volk ML, Jensen D, Di Bisceglie AM, Schoenfeld PS. A sustained viral response is associated with reduced liver-related morbidity and mortality in patients with hepatitis C virus. Clin Gastroenterol Hepatol. 2010;8(3):280-8, 288.e1.  PMID: 19948249 
  5. Simmons B, Saleem J, Heath K, Cooke GS, Hill A. Long-term treatment outcomes of patients infected with hepatitis C virus: A systematic review and meta-analysis of the survival benefit of achieving a sustained virological response. Clin Infect Dis. 2015;61(5):730-40.  https://doi.org/10.1093/cid/civ396  PMID: 25987643 
  6. Carrat F, Fontaine H, Dorival C, Simony M, Diallo A, Hezode C, et al. Clinical outcomes in patients with chronic hepatitis C after direct-acting antiviral treatment: a prospective cohort study. Lancet. 2019;393(10179):1453-64.  https://doi.org/10.1016/S0140-6736(18)32111-1  PMID: 30765123 
  7. World Health Organization (WHO). Global Health Sector Strategy on Viral Hepatitis 2016-2021- Towards ending viral hepatitis. 2016. Geneva: WHO; 2016. [accessed Dec 2018]. Available from: https://apps.who.int/iris/bitstream/handle/10665/246177/WHO-HIV-2016.06-eng.pdf;jsessionid=B414D1806598317BE385218FA7F29E6A?sequence=1
  8. Public Health England (PHE). Annual report from the sentinel surveillance study of blood borne virus testing in England: data for January to December 2017. 2018.London: PHE; 2018. [accessed Dec 2018]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/746267/hpr3618_bbv-ss.pdf
  9. Brant LJ, Hurrelle M, Balogun MA, Klapper P, Ahmad F, Boxall E, et al. Sentinel laboratory surveillance of hepatitis C antibody testing in England: understanding the epidemiology of HCV infection. Epidemiol Infect. 2007;135(3):417-26.  https://doi.org/10.1017/S0950268806006832  PMID: 16836798 
  10. Office for National Statistics (ONS). Reference for data methodology. Mortality statistics in England and Wales QMI. 2018. London/Newport/Titchfield: ONS; [accessed July 2019]. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/methodologies/mortalitystatisticsinenglandandwalesqmi
  11. World Health Organization (WHO). ICD-10 Version: 2016. Geneva: WHO; [accessed July 2019]. Available from: https://icd.who.int/browse10/2016/en
  12. National Health Services Scotland (NHS Scotland). Standardisation Guidance: Calculation of standardised rates and ratios: Direct and indirect methods. 2016. Edinburgh: NHS Scotland; 2016. [accessed Dec 2018]. Available from: https://www.scotpho.org.uk/media/1400/phi-standardisation-guidance-v21.docx
  13. Kim HJ, Fay MP, Feuer EJ, Midthune DN. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med. 2000;19(3):335-51.  https://doi.org/10.1002/(SICI)1097-0258(20000215)19:3<335::AID-SIM336>3.0.CO;2-Z  PMID: 10649300 
  14. Poynard T, Bedossa P, Opolon P. Natural history of liver fibrosis progression in patients with chronic hepatitis C. The OBSVIRC, METAVIR, CLINIVIR, and DOSVIRC groups. Lancet. 1997;349(9055):825-32.  https://doi.org/10.1016/S0140-6736(96)07642-8  PMID: 9121257 
  15. Sutton AJ, Gay NJ, Edmunds WJ, Hope VD, Gill ON, Hickman M. Modelling the force of infection for hepatitis B and hepatitis C in injecting drug users in England and Wales. BMC Infect Dis. 2006;6(1):93.  https://doi.org/10.1186/1471-2334-6-93  PMID: 16762050 
  16. Office for National Statistics (ONS). Deaths related to drug poisoning in England and Wales: 2017 registrations 2018. Newport: ONS; [accessed Aug 2010]. Available from: https://www.gov.uk/government/statistics/deaths-related-to-drug-poisoning-in-england-and-wales-2017-registrations
  17. Aspinall EJ, Hutchinson SJ, Janjua NZ, Grebely J, Yu A, Alavi M, et al. Trends in mortality after diagnosis of hepatitis C virus infection: an international comparison and implications for monitoring the population impact of treatment. J Hepatol. 2015;62(2):269-77.  https://doi.org/10.1016/j.jhep.2014.09.001  PMID: 25200903 
  18. Public Health England (PHE). Unlinked anonymous HIV and viral hepatitis monitoring among PWID: 2018 report. 2018.London: PHE; 2018. [accessed Dec 2018]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/729614/hpr2718_uam-pwid.pdf
  19. Public Health England (PHE). National Statistics- Alcohol and drug treatment for adults: statistics summary 2017 to 2018. 2018. London; PHE; 2018. [accessed Dec 2018]. Available from: https://www.gov.uk/government/publications/substance-misuse-treatment-for-adults-statistics-2017-to-2018/alcohol-and-drug-treatment-for-adults-statistics-summary-2017-to-2018
  20. Baden R, Rockstroh JK, Buti M. Natural history and management of hepatitis C: does sex play a role? J Infect Dis. 2014;209(Suppl 3):S81-5.  https://doi.org/10.1093/infdis/jiu057  PMID: 24966194 
  21. Bakr I, Rekacewicz C, El Hosseiny M, Ismail S, El Daly M, El-Kafrawy S, et al. Higher clearance of hepatitis C virus infection in females compared with males. Gut. 2006;55(8):1183-7.  https://doi.org/10.1136/gut.2005.078147  PMID: 16434426 
  22. Ostapowicz G, Watson KJ, Locarnini SA, Desmond PV. Role of alcohol in the progression of liver disease caused by hepatitis C virus infection. Hepatology. 1998;27(6):1730-5.  https://doi.org/10.1002/hep.510270637  PMID: 9620350 
  23. Public Health England (PHE). Hepatitis C in the UK, 2018 report: Working to eliminate hepatitis C as a major public health threat. 2018.London: PHE; 2018. [accessed Dec 2018]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/732469/HCV_IN_THE_UK_2018_UK.pdf
  24. Simmons R, Ireland G, Ijaz S, Ramsay M, Mandal S. Unpublished: Causes of death among persons diagnosed with hepatitis C infection in the pre and post DAA era in England: a record linkage study. Journal of Viral hepatitis. 2019. Vol 26, Issue 7: 873-880.
  25. Mahajan R, Xing J, Liu SJ, Ly KN, Moorman AC, Rupp L, et al. Mortality among persons in care with hepatitis C virus infection: the Chronic Hepatitis Cohort Study (CHeCS), 2006-2010. Clin Infect Dis. 2014;58(8):1055-61.  https://doi.org/10.1093/cid/ciu077  PMID: 24523214 
  26. Keiser O, Giudici F, Müllhaupt B, Junker C, Dufour J-F, Moradpour D, et al. Trends in hepatitis C-related mortality in Switzerland. J Viral Hepat. 2018;25(2):152-60.  https://doi.org/10.1111/jvh.12803  PMID: 29159841 
  27. Lazarus JV, Mozalevskis A, Safreed-Harmon K, Eramova I. Strengthening hepatitis B and C surveillance in Europe: results from the two global hepatitis policy surveys (2013 and 2014). Hepatol Med Policy. 2016;1(1):3.  https://doi.org/10.1186/s41124-016-0009-5  PMID: 30288307 
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