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Published on: December 15, 2023
Liver-related mortality among people with hepatitis B and C: Evaluation of definitions based on linked healthcare
Syed Hassan Bin Usman Shah1, Maryam Alavi1, Behzad Hajarizadeh1
1The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.
Insights
Healthcare administrative data can monitor hepatitis B (HBV) and C (HCV) mortality. However, death certificates alone have limitations; combining them with hospitalization data offers a more accurate picture of liver disease deaths.
Area of Science:
- Public Health
- Epidemiology
- Health Informatics
Background:
- Routinely collected healthcare administrative data offer potential for monitoring mortality in individuals with hepatitis B (HBV) and C (HCV).
- Accurate tracking of liver-related mortality is crucial for understanding disease burden and guiding public health interventions.
Purpose of the Study:
- To evaluate the concordance between hospitalization records for end-stage liver disease (ESLD) and death certificates in identifying liver-related mortality among people notified with HBV or HCV.
- To assess the accuracy of death certificate data in capturing HBV and HCV-related liver disease mortality.
Main Methods:
- Linked administrative datasets from New South Wales, Australia, including HBV/HCV notifications, hospital admissions, and mortality data (1993-2018).
- Defined ESLD hospitalization as first admission for decompensated cirrhosis (DC) or hepatocellular carcinoma (HCC).
- Compared liver death definitions from ESLD hospitalizations with primary and secondary cause-specific death certificate data (ESLD-related and all-liver deaths).
Main Results:
- Among HBV and HCV cases with post-ESLD hospitalization deaths, a significant proportion had discrepancies with death certificate records.
- For HBV, 63% of post-ESLD deaths had ESLD recorded on death certificates, and 83% had liver disease recorded.
- For HCV, 58% of post-ESLD deaths had ESLD recorded, and 87% had liver disease recorded; over one-third of DC/HCC death certificates lacked mention of HBV, HCV, or viral hepatitis.
Conclusions:
- Death certificate data alone are insufficient for accurately estimating and tracking HBV and HCV liver disease mortality.
- Linking ESLD hospitalization data with vital status information, or combining it with cause-specific death certificate data, provides a more optimal approach for mortality monitoring.
Abstract:
Routinely collected and linked healthcare administrative datasets could be used to monitor mortality among people with hepatitis B (HBV) and C (HCV). This study aimed to evaluate the concordance in records of liver-related mortality among people with an HBV or HCV notification, between data on hospitalization for end-stage liver disease (ESLD) and death certificates. In New South Wales, Australia, HBV and HCV notifications (1993-2017) were linked to hospital admissions (2001-2018), all-cause mortality (1993-2018) and cause-specific mortality (1993-2016) datasets. Hospitalization for ESLD was defined as a first-time hospital admission due to decompensated cirrhosis (DC) or hepatocellular carcinoma (HCC). Consistency of liver death definition of mortality following hospitalization for ESLD was compared with two death certificate-based definitions of liver deaths coded among primary and secondary cause-specific mortality data, including ESLD-related (deaths due to DC and HCC) and all-liver deaths (ESLD-related and other liver-related causes). Of 63,292 and 107,430 individuals with an HBV and HCV notification, there were 4478 (2.6%) post-ESLD hospitalization deaths, 5572 (3.3%) death certificate liver disease deaths and 2910 (1.7%) death certificate ESLD deaths. Between 2001 and 2016, among HBV post-ESLD hospitalization deaths (n = 891), 63% (562) had death certificate ESLD recorded, and 83% (741) had death certificate liver disease recorded. Between 2001 and 2016, among HCV post-ESLD hospitalization deaths (n = 3587), 58% (2082) had death certificate ESLD recorded, and 87% (3135) had death certificate liver disease recorded. At least one-third of death certificates with DC and HCC as cause of death had no mention of HBV, HCV or viral hepatitis. Our study identified limitations in estimating and tracking HBV and HCV liver disease mortality using death certificate-based data only. The optimum data for this purpose is either ESLD hospitalisations with vital status information or a combination of these with cause-specific death certificate data.
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