Causes of Death after Diagnosis of Hepatitis B or C

Hepatitis B and C are common causes of death related to liver disease. As reported in the September 9, 2006 issue of The Lancet, researchers from Australia conducted a large community-based linkage study to investigate all causes of mortality among patients with hepatitis B or C virus (HBV or HCV) infection.

The study included 39,109 individuals with hepatitis B; 75,834 with hepatitis C; and 2604 coinfected with both HBV and HCV reported to the New South Wales state health department between 1990 and 2002. Data from these patients were probabilistically linked to the National Death Index, and standardized mortality ratios for all causes of death were calculated.

The same team reported on cancer incidence among people with hepatitis B or C in the August 2006 Journal of Hepatology .

Results

The numbers of deaths identified by the linkage were 1233 (3.2%) for hepatitis B, 4008 (5.3)% for hepatitis C, and 186 (7.1)% for HBV-HCV coinfection.

People with HBV, HCV, or HBV-HCV coinfection had elevated rates of mortality due to liver-related causes (standardized mortality ratios of 12.2, 16.8, and 32.9, respectively) and drug-induced death (1.4, 19.3, and 24.7, respectively).

In people with hepatitis C, the elevated risk of death due to drug-related causes was significantly greater than that for liver-related causes (P = 0.012).

The greatest excess risk was observed among women aged 15-24 years.

Hepatocellular carcinoma (HCC) was the most common liver-related cause of death in people with chronic hepatitis B.

Conclusion

The researchers concluded that all three groups (HBV, HBV, and HBV-HCV coinfected) had "increased risk of liver-related death compared with the standard population, with the greatest excess in people diagnosed with hepatitis B and hepatitis C coinfection."

"Our data highlight that young people with hepatitis C and with coinfection face a higher mortality risk from continued drug use than from their infection, whereas the main cause of hepatitis B death was liver-related," they wrote.

Among people with either virus, the risk of liver-related death may be reduced by early antiviral treatment. In addition, the risk of death due to hepatitis B may be reduced through more widespread vaccination.

09/22/06

Reference
J Amin, M G Law, M Bartlett, and others. Causes of death after diagnosis of hepatitis B or hepatitis C infection: a large community-based linkage study. The Lancet 368(9539): 938-945. September 9, 2006.