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All-Cause and Cause-Specific Mortality in Middle-Aged Individuals with Positive HBsAg: Findings from a Prospective
Nazgol Motamed-Gorji1, Sareh Eghtesad1, Maryam Sharafkhah1
1Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Hepatitis B virus (HBV) infection increases mortality risk in Iranian adults. While liver disease is a concern, cardiovascular diseases and extrahepatic cancers are leading causes of death in HBV patients.
Area of Science:
- Epidemiology
- Hepatology
- Public Health
Background:
- Hepatitis B virus (HBV) is a leading cause of liver transplants in Iran.
- Mortality patterns in Iranian HBV patients remain poorly understood.
- This study addresses the need for comprehensive mortality data in this population.
Purpose of the Study:
- To investigate all-cause mortality among individuals positive for Hepatitis B surface antigen (HBsAg).
- To determine cause-specific mortality risks associated with HBsAg positivity in Iran.
- To identify leading causes of death in a large cohort of Iranian adults with HBV.
Main Methods:
- Utilized data from the Golestan Cohort Study (n=49,667) with a median follow-up of 11.33 years.
- Excluded individuals with hepatitis C coinfection.
- Employed Cox proportional hazard models to assess the association between HBsAg status and mortality outcomes.
Main Results:
- HBsAg positive individuals exhibited increased all-cause mortality (aHR=1.15) and significantly higher liver-related mortality (aHR=7.13).
- Higher risks of colorectal and pancreatic cancers were observed in male HBsAg positive participants.
- Cardiovascular diseases and extrahepatic malignancies were the primary causes of death, even in the HBsAg positive group.
Conclusions:
- HBV infection is linked to elevated mortality risks from various causes in Iranian adults.
- Focusing solely on liver-related outcomes in Iranian HBV patients risks overlooking critical non-liver mortality causes.
- Cardiovascular diseases and extrahepatic cancers represent significant, often leading, causes of death in HBsAg positive individuals.
Background:
While hepatitis B virus (HBV) is the most prevalent cause of adult liver transplants in Iran, the mortality rates and leading causes of death in HBV patients are not well-understood. This study aimed to investigate all-cause and cause-specific mortality among HBsAg positive individuals in a large Iranian cohort.
Methods:
The Golestan Cohort Study includes 50045 individuals aged 40-75 residing in Iran's Golestan province, enrolled during 2004-2008. HBsAg test was performed at baseline. For the present study, individuals with hepatitis C coinfection were excluded. All-cause mortality was considered as the primary outcome. The association between HBsAg and different mortality causes was evaluated using Cox proportional hazard models. P value<0.05 was considered significant.
Results:
The current study included 49667 participants. After 11.33 (median) follow-up years, there were 7,686 total deaths, with 635 deaths in the HBsAg positive group. In the multivariate Cox proportional hazard model, HBsAg positive individuals had higher all-cause (adjusted hazard ratio [aHR]=1.15, 95% CI: 1.06-1.24) and liver-related mortality risk (aHR=7.13; 5.19-9.79). Mortality from colorectal and pancreatic cancers was higher among male HBsAg positive participants (aHRs=2.41 and 2.22, respectively). Nevertheless, cardiovascular diseases (CVDs) and extrahepatic malignancies were the leading causes of death among both HBsAg positive and negative individuals, and liver-related deaths contributed to an overall 10% of deaths in HBsAg positive patients.
Conclusion:
HBV is associated with significant mortality risk from different causes in Iranian adults. However, solely focusing on liver outcomes in Iranian HBV patients might result in overlooking non-liver events, especially CVD and extrahepatic cancers.
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