Changing trends in hepatitis C-related mortality in the United States, 1995-2004

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Changing trends in hepatitis C-related mortality in the United

States, 1995-2004 - attachment is detailed report with graphs/tables

Hepatology March 2008 Advance Publication

Wise 1 2 *§, Bialek 3, Lyn Finelli 3, Beth P. Bell

3, Sorvillo 1 2

1Department of Epidemiology, School of Public Health, University of

California, Los Angeles

2Data Collection and Analysis Unit, Office of Health Assessment and

Epidemiology, Los Angeles County Department of Public Health, Los

Angeles, CA

3Division of Viral Hepatitis, National Center for HIV/AIDS, Viral

Hepatitis, STD and TB Prevention, Centers for Disease Control and

Prevention, Atlanta, GA

Funded by:

NIH/NIAID T32AI07481: Interdisciplinary Training Program in HIV/AIDS

Epidemiology

Note from Jules: the most dramatic mortality data is reflected in age

groups 45-64 and among African-Americans and Hispanics. Look at he

tables and graphs below and you'll dramatic impact on mortality by

HCV in these groups. Clearly, the age impact is because people

infected 20+ years ago are now dying since in monoinfection it takes

on average 20 years to progress to cirrhosis. This progression is

accelerated in HIV/HCV coinfection so you'll see in the article that

the average age of death among coinfected is much lower, about 55 vs

47 yrs. The difference in mortality between African-Americans &

Hispanics and whites is dramatic, which you'll see by looking at the

graphs and tables below, with skyrocketing death rates among African-

Americans and Latinos and somewhat of a leveling off among whites.

Perhaps this reflects differences in acess to care and treatment and

response rates to interferon-based therapy.

“The most dramatic age-specific increases during the study period

were observed among persons 45-54 years of age and persons 55-64

years of age, with rates increasing 376% from 1.76 to 8.01 per

100,000 and 188% from 2.22 to 6.05 per 100,000, respectively (Fig. 2,

Table 1)…..Age-adjusted race/ethnicity-specific mortality rates

also increased over the study period for all groups, with the most

rapid increases among non-Hispanic blacks and Native Americans/Alaska

Natives (Fig. 3, Table 1). Some of the most substantial mortality

rate increases observed among specific subgroups during the study

period were among non-Hispanic black males aged 55-64 (3.81 to 21.94

per 100,000) and non-Hispanic white males aged 45-54 (2.21 to 11.34

per 100,000).â€

Abstract

The disease burden and mortality from hepatitis C are predicted to

increase in the United States as the number of persons with long-

standing chronic infection grows. We analyzed hepatitis C mortality

rates derived from US Census and multiple-cause-of-death data for

1995-2004. Deaths were considered hepatitis C-related if: (1)

hepatitis C was the underlying cause of death, (2) chronic liver

disease was the underlying cause and hepatitis C was a contributing

cause, or (3) human immunodeficiency virus was the underlying cause

and chronic liver disease and hepatitis C were contributing causes. A

total of 56,409 hepatitis C-related deaths were identified.

Mortality rates increased 123% during the study period (1.09 per

100,000 persons to 2.44 per 100,000), but average annual increases

were smaller during 2000-2004 than 1995-1999. After peaking in 2002

(2.57 per 100,000), overall rates declined slightly, but continued to

increase among persons aged 55-64 years.

Overall increases were greater among males (144%) than females (81%)

and among non-Hispanic blacks (170%) and Native Americans (241%)

compared to non-Hispanic whites (124%) and Hispanics (84%).

The 7,427 hepatitis C deaths in 2004 (mean age: 55 years),

corresponded to 148,611 years of potential life lost.

The highest mortality rates in 2004 were observed among males,

persons aged 45-54 and 55-64 years, Hispanics, non-Hispanic blacks,

and non-Hispanic Native American/Alaska Natives.

Conclusion: Overall, hepatitis C mortality has increased

substantially since 1995. Despite small declines in recent years,

rates have continued to increase among persons aged 55-64 years.

Hepatitis C is an important cause of premature mortality.

Article Text

Hepatitis C virus (HCV) infection is the most common blood-borne

infection in the United States, with an estimated 1.3% of the general

US population chronically infected.[1] About 10%-20% of chronically

infected persons will develop liver cirrhosis and 1%-5% will develop

hepatocellular carcinoma within 20-30 years of infection.[2] In a

2005 report, chronic HCV infection was shown to be the leading

indication for liver transplantation in the United States.[3]

Alcohol use, age at infection, duration of HCV infection, and male

sex are all associated with progression of liver fibrosis,

development of cirrhosis, and subsequent mortality among persons with

chronic HCV infection.[4][5] Coinfection with human immunodeficiency

virus (HIV) is also an important prognostic factor influencing the

course of HCV infection[6] and occurs commonly among persons infected

with HCV due to injection drug use and other shared modes of

transmission. Advances in antiretroviral therapy have extended the

life of many HIV-infected persons, such that persons coinfected with

HIV and HCV often live long enough to develop the sequelae of

hepatitis C-related chronic liver disease.[7] Liver disease is now a

leading cause of death among persons infected with HIV.[8]

Several lines of evidence suggest that the disease burden and

mortality from chronic HCV infection may increase in the coming

years. Comparison of the age-specific prevalence of HCV infection

during 1988-1994 and 1999-2002 showed that the peak prevalence of

infection had shifted from persons 30-39 years of age to persons 40-

49 years of age, and that approximately two-thirds of infected

participants in both surveys were born between 1945 and 1964.[1][9]

These data, as well as results of mathematical models, suggest that

the number of persons chronically infected for more than 20 years

will continue to rise over the next decade.[10]

Results of a mathematical modeling study predicted that the annual

number of hepatitis C-related deaths would increase from an estimated

8,000 in 1991 to 18,000 annually between 2010 and 2019, based on past

hepatitis C mortality, hepatocellular carcinoma incidence, liver

transplantation, alcohol use, and mortality related to other causes.

[11]

Few studies provide data on the population impact of chronic HCV

infection on mortality in the United States, largely due to the

difficulty of correctly identifying the infection as a cause of

death. Using US death record data, Vong and Bell found that 4,443

deaths were linked to hepatitis C in 1998, a 220% increase in age-

adjusted mortality rates since 1993, although these numbers were

considered to be an underestimate.[12] In addition, these data are

now nearly a decade old, a time period in which large increases in

hepatitis C-related mortality were expected.

We examined United States multiple-cause-of-death (MCOD) data from

1995-2004 in order to provide more current, population-based

estimates of trends and demographic differences in hepatitis C-

related mortality utilizing a broader case definition than has been

employed in previous population-based studies of hepatitis C-related

mortality