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Mortality among persons in care with hepatitis C virus infection: the Chronic Hepatitis Cohort Study (CHeCS),
Reena Mahajan1, Jian Xing, Stephen J Liu
1Centers for Disease Control and Prevention, Atlanta, Georgia.
Insights
Hepatitis C virus (HCV) infection is underdocumented on death certificates, with actual mortality rates significantly higher than recorded. Many HCV deaths are misattributed, masking the true impact of the virus.
Area of Science:
- Hepatology
- Public Health
- Epidemiology
Background:
- Increasing deaths among Hepatitis C Virus (HCV)-infected individuals in the US.
- Lack of clear understanding of actual mortality rates and causes of death in HCV patients.
Purpose of the Study:
- To compare mortality data of HCV-infected patients with national death certificate data.
- To elucidate the true mortality rates and causes of death in HCV-infected individuals.
Main Methods:
- Observational cohort study (Chronic Hepatitis Cohort Study - CHeCS) of HCV patients.
- Comparison of CHeCS mortality data with US multiple cause of death (MCOD) data (2006-2010).
- Analysis of premortem diagnoses, liver biopsies, and FIB-4 scores.
Main Results:
- HCV patients died younger (mean age 59) than the general population.
- Liver disease mortality rate in HCV patients was 12 times higher than the general population.
- HCV was listed on death certificates for only 19% of decedents, despite evidence of chronic liver disease in most.
Conclusions:
- HCV infection is significantly underdocumented on US death certificates.
- Estimated actual number of HCV deaths in 2010 may be five times higher than recorded.
- A majority of HCV-infected individuals who died had premortem indications of chronic liver disease.
Background:
The number of deaths in hepatitis C virus (HCV)-infected persons recorded on US death certificates has been increasing, but actual rates and causes of death in these individuals have not been well elucidated.
Methods:
Disease-specific, liver-related, and non-liver-related mortality data for HCV-infected patients in an observational cohort study, the Chronic Hepatitis Cohort Study (CHeCS) at 4 US healthcare systems, were compared with multiple cause of death (MCOD) data in 12 million death certificates in 2006-2010. Premortem diagnoses, liver biopsies, and FIB-4 scores (a noninvasive measure of liver damage) were examined.
Results:
Of 2 143 369 adult patients seen at CHeCS sites in 2006-2010, 11 703 (0.5%) had diagnosed chronic HCV infection, and 1590 (14%) died. The majority of CHeCS decedents were born from 1945 to 1965 (75%), white (50%), and male (68%); mean age of death was 59 years, 15 years younger than MCOD deaths. The age-adjusted mortality rate for liver disease in CHeCS was 12 times higher than the MCOD rate. Before death, 63% of decedents had medical record evidence of chronic liver disease, 76% had elevated FIB-4 scores, and, among those biopsied, 70% had moderate or worse liver fibrosis. However, only 19% of all CHeCS decedents and only 30% of those with recorded liver disease had HCV listed on their death certificates.
Conclusions:
HCV infection is greatly underdocumented on death certificates. The 16 622 persons with HCV listed in 2010 may represent only one-fifth of about 80 000 HCV-infected persons dying that year, at least two-thirds of whom (53 000 patients) would have had premortem indications of chronic liver disease.
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