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Estimated progression rates in three United Kingdom hepatitis C cohorts differed according to method of recruitment
Michael J Sweeting1, Daniela De Angelis, Keith R Neal
1MRC Biostatistics Unit, Institute of Public Health, Robinson Way, Cambridge CB2 2SR, United Kingdom. Michael.sweeting@mrc-bsu.cam.ac.uk
Insights
Hepatitis C virus (HCV) progression to cirrhosis varies significantly based on how patient cohorts are recruited. Different recruitment methods yield different disease progression rates, impacting research findings.
Area of Science:
- Hepatology
- Viral Hepatitis Research
- Clinical Epidemiology
Background:
- Hepatitis C virus (HCV) infection can lead to progressive liver disease, including cirrhosis.
- Accurate estimation of HCV progression rates is crucial for understanding disease trajectory and patient outcomes.
- Observational studies are key to tracking disease progression in real-world settings.
Purpose of the Study:
- To estimate the rates of hepatitis C virus (HCV) disease progression between stages preceding cirrhosis.
- To analyze how different cohort recruitment strategies influence the estimation of HCV progression rates.
- To compare HCV progression across distinct observational cohorts.
Main Methods:
- Utilized data from three United Kingdom observational cohorts comprising 987 HCV-infected patients.
- Employed liver biopsy scores to determine the stage of HCV-related liver disease.
- Applied a three-state continuous time Markov model to estimate disease progression probabilities.
Main Results:
- Disease progression rates varied considerably between the three cohorts after adjusting for confounders.
- Estimated 20-year probability of cirrhosis: 12% (hospital-based), 6% (posttransfusion), and 23% (tertiary referral).
- These differences highlight the impact of cohort recruitment on estimated progression rates.
Conclusions:
- The method used for cohort recruitment significantly influences the derived estimates of HCV disease progression.
- Researchers must consider cohort selection bias when interpreting HCV progression data.
- Awareness of recruitment methodology is essential for accurate epidemiological studies of HCV.
Objectives:
To estimate hepatitis C virus (HCV) progression rates between disease stages prior to cirrhosis, using data from liver biopsies in three observational cohorts. To demonstrate how the method of cohort recruitment can influence the estimation of HCV-progression rates.
Study Design And Setting:
Data came from three United Kingdom observational cohorts, assembled from different referral sources. In total, 987 HCV-infected patients with an estimated (or known) date of infection and at least one histologically scored liver biopsy were eligible for inclusion in the analysis. Liver biopsy scores were used to determine the stage of HCV-related liver disease. A three-state continuous time Markov model was used to estimate covariate-specific average probabilities of progression of disease.
Results:
After adjusting for confounders, considerably different rates of disease progression were estimated in the three cohorts. For a group of patients with the same demographics, the estimated 20-year probability of progression to cirrhosis was 12% (95% confidence interval CI = 6-22) in a hospital-based cohort, 6% (95% CI = 3-13) in a posttransfusion cohort, and 23% (95% CI = 14-37) in a cohort recruited from a tertiary referral center.
Conclusion:
Researchers using estimates of disease progression should be aware that the method of cohort recruitment has considerable influence on the progression rates that are derived.
