Mortality Due to Hepatitis C in the U.S.: Has the Worst Passed?

By Liz Highleyman

Liver disease due to chronic hepatitis C virus (HCV) infection typically takes years or decades to progress to advanced stages, so many people infected long ago have recently begun to develop cirrhosis, hepatocellular carcinoma (HCC), and end-stage liver failure necessitating transplantation.

Public health authorities have warned that morbidity and mortality associated with chronic hepatitis C are likely to increase in the coming years. However, a study presented at the Digestive Disease Week 2008 conference last month in San Diego suggests that overall HCV-related mortality may have already reached a plateau.

As background, the study investigators noted that recent analysis of liver transplant waiting lists indicated that the number of patients registered for end-stage liver disease due to hepatitis C had decreased since 2000, but that registration for HCC continued to rise.

To learn more about longitudinal trends in the death rate secondary to hepatitis C in the U.S., the researchers collected information from the national death registry. All records of individuals over age 19 for which HCV was listed as an underlying or immediate cause of death were extracted for the period 1994-2003. The investigators also identified records that specified HCC. Death rates were calculated using the age, sex, and race/ethnicity distribution of the standard U.S. population.

Results

• Between 1994 and 2003, there were 75,019 total reported deaths of individuals with an HCV diagnosis.

• Of these, 48,381 had HCV as the underlying or immediate cause of death.

• 65% of these deaths were among men.

• The mean age at the time of death was 55 years.

• 5,487 records specified HCC.

• For individuals with HCC, the mean age at death was 58 years.

• The majority of deceased individuals were white (80%; n=38,672), followed by African American (16%; n=7758) and other race/ethnicity (4%; n=1951).

• The overall HCV death rate adjusted for age and sex was 1.2 per 100,000 persons per year in 1994.

• This increased to 3.3 in 2002, but then leveled off at 3.1 in 2003.

• Overall non-HCC mortality increased though 2000, when it reached a plateau.

• While this trend was observed in all races, the mortality was nearly twice as high among African Americans.

• Death rates for HCC also declined slightly among whites, but continued to rise among African Americans.

Conclusion

Based on these findings, the researchers suggested that previous forecasts projecting that HCV mortality would continue to increase well into the second decade of the current century might be incorrect.

"These data suggest that HCV death rate may have already reached a plateau, if not started a decline," they concluded.

However, they added, "deaths from HCC remain on the rise" among non-whites.

6/06/08

Reference
WR Kim, RA Pedersen, AA Hindman, and others. Mortality from hepatitis C in the US: has the worst passed? Digestive Disease Week (DDW) 2008. San Diego, CA. May 17-22, 2008. Abstract T1012.