Two Studies Assess Hepatitis C and Mortality

Hepatitis C often goes unreported on death certificates and people who have the virus are more likely to die younger than those who don't, according to results from 2 mortality studies.

A blood borne illness that can severely damage the liver, hepatitis C virus (HCV) kills 1 to 5 of every 100 infected people as a result of chronic infection, according to estimates from the Centers for Disease Control and Prevention (CDC). The impact of HCV on mortality in the U.S. is assessed in 2 studies presented in the February issue of Clinical Infectious Diseases.

New York Study

In one study, researchers in New York City cross-matched a decade of surveillance data from disease registries with mortality data to analyze factors associated with death among adults who have HCV. The data review, conducted by New York City Department of Health and Mental Hygiene, looked at cause and age of death and compared deaths among people coinfected with HIV to those without it.

From 2000 to 2011, there were 13,307 HCV monoinfected adults who died, and 5,475 adults coinfected with HCV/HIV who died among the population studied. People who had HCV monoinfection were more likely to have died of liver cancer, drug-related causes and cirrhosis than people without the infection.

Similarly, people with coinfections of HCV/HIV were more likely to have died of liver cancer and drug-related causes compared with people without either infection. Among people who had coinfections, 53.6% of deaths were attributed to HIV/AIDS and 94% of deaths occurred before age 65.

Researchers concluded that HCV-infected adults have a higher risk of dying - particularly from HIV/AIDS or drug use and other HCV-associated conditions - and were more likely to die prematurely compared to people in the general population.

CDC Study

Record keeping on cause of death among people with HCV remains somewhat murky even as the death toll among this population rises in the U.S. In a separate observational study, researchers with the CDC examined the effect of HCV on mortality among more than 2 million patients seen at 4 U.S health care sites identified as the Chronic Hepatitis Cohort Study (CHeCS). They compared mortality findings from this cohort to Multiple Cause of Death (MCOD) data gleaned from 12 million general population death certificates from 2006 to 2010.

Among the cohort of 11,703 patients who had been diagnosed with chronic HCV, 1590 (14%) died during the study period. Three fourths of those who died had been born from 1945 to 1965, half were white, 68% were men and the mean age at time of death was 59 years, which was 15 years younger than the 74 years reported in the general population.

The study found that patients whose death certificates listed HCV had an age-adjusted mortality rate for liver disease that was 12 times higher than the general population comparison group. The CDC researchers noted that despite confirmed chronic HCV infection among those who died, only 19% had hepatitis C listed as an underlying cause on their death certificates.

Study authors concluded that HCV infection is greatly underdocumented on death certificates. They estimated that the number of deaths recorded in 2010 among people with HCV represent only one fifth of the roughly 80,000 HCV-infected who died that year, and that more than half (53,000) had indications of chronic liver disease while still alive.

Disclosure: CHeCS is funded by the CDC Foundation, which receives grants from AbbVie, Abbott, Genetech, Janssen, Johnson & Johnson, and Vertex.