Geographical variation in hepatitis C-related severe liver disease and patient risk factors: a multicentre...

Despite promising steps towards the elimination of hepatitis C virus (HCV) in the UK, several indicators provide a cause for concern for future disease burden. We aimed to improve understanding of geographical variation in HCV-related severe liver disease and historic risk factor prevalence among clinic attendees in England and Scotland. We used metadata from 3829 HCV-positive patients consecutively enrolled into HCV Research UK from 48 hospital centres in England and Scotland during 2012-2014. Employing mixed-effects statistical modelling, several independent risk factors were identified: age 46-59 y (OR_adj 3.06) and ≥60 y (OR_adj 5.64) relative to <46 y, male relative to female sex (OR_adj 1.58), high BMI (OR_adj 1.73) and obesity (OR_adj 2.81) relative to normal BMI, diabetes relative to no diabetes (OR_adj 2.75), infection with HCV genotype (GT)-3 relative to GT-1 (OR_adj 1.75), route of infection through blood products relative to injecting drug use (OR_adj 1.40), and lower odds were associated with black ethnicity (OR_adj 0.31) relative to white ethnicity. A small proportion of unexplained variation was attributed to differences between hospital centres and local health authorities. Our study provides a baseline measure of historic risk factor prevalence and potential geographical variation in healthcare provision, to support ongoing monitoring of HCV-related disease burden and the design of risk prevention measures.