Racial diversity in mortality and morbidity in urban patients with hepatitis C

Area of Science:

• Hepatology and Viral Gastroenterology
• Clinical Epidemiology
• Public Health

Background:

• Understanding racial disparities in mortality for chronic hepatitis C virus (HCV) infection is crucial for patient counseling and treatment strategies.
• Previous research has not fully elucidated the influence of racial diversity on mortality and morbidity in HCV-infected populations.

Purpose of the Study:

• To investigate the impact of racial diversity on mortality and morbidity among a cohort of HCV-infected patients.
• To identify factors associated with increased mortality in chronic hepatitis C patients.
• To evaluate the effect of treatment and sustained viral response (SVR) on mortality.

Main Methods:

• Retrospective analysis of 3724 HCV-infected patients (African Americans, Caucasians, and others) from an urban clinic (1995-2008).
• Mortality data collected through the SSA National Death Index as of 2011 and correlated with early medical information.
• Assessment of factors including cirrhosis, fibrosis, low albumin, diabetes, renal impairment, and cardiac symptoms.

Main Results:

• No significant difference in mortality rates between African American and Caucasian patients (23% vs 22%).
• Factors associated with increased mortality included cirrhosis, fibrosis, low albumin, diabetes, renal impairment, and cardiac symptoms.
• Patients achieving SVR had significantly lower mortality compared to untreated patients (5% vs 26-27%). Nonresponding African Americans also showed lower mortality.

Conclusions:

• Race is not a determining factor in early mortality for chronic hepatitis C patients.
• Achieving SVR is strongly associated with reduced mortality in both African American and Caucasian patients.
• African American patients with renal impairment and low albumin are at highest risk and require prompt treatment.