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Causal Mediation Analyses for the Natural Course of Hepatitis C: A Prospective Cohort Study

Yi-Ting Huang1,2, Yao-Chun Hsu3,4,5,6, Hwai-I Yang7,8,9,10

  • 1Institute of Statistical Science, Academia Sinica.

Journal of Epidemiology
|August 4, 2024
PubMed

Insights

Hepatitis C virus (HCV) infection causes mortality through both liver and non-liver diseases. Understanding these pathways, including septicemia and renal disease, is key to reducing preventable deaths from HCV.

Area of Science:

  • Hepatology
  • Infectious Diseases
  • Epidemiology

Background:

  • Hepatitis C virus (HCV) infection is a systemic illness with unclear mortality mediation pathways.
  • Quantifying the roles of intrahepatic and extrahepatic diseases in HCV-induced mortality is crucial for public health resource allocation.

Purpose of the Study:

  • To comprehensively quantify the extent to which intrahepatic and extrahepatic diseases mediate mortality in Hepatitis C virus (HCV) infected individuals.

Main Methods:

  • A community-based cohort study in Taiwan with over 25 years of follow-up.
  • Linking cohort data with Taiwan's National Health Insurance Research Database.
  • Employing causal mediation analyses to assess 34 candidate diseases' mediation effects on HCV-related mortality.

Main Results:

  • Intrahepatic diseases mediated 54.1% of HCV-induced mortality (e.g., liver cirrhosis, liver cancer).
  • Extrahepatic diseases mediated 45.9%, notably septicemia (25.2%), renal disease (16.7%), and blood/immune diseases (12.2%).
  • A dose-response relationship between HCV viral load and mortality mediation was observed.

Conclusions:

  • Both intrahepatic and extrahepatic conditions significantly contribute to Hepatitis C virus (HCV)-induced mortality.
  • Findings highlight the systemic impact of HCV and support viral load as a key factor in mortality mediation.
Abstract

Keywords:
cohort studydisease burdenhepatitis Cmediation analysisnatural history

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