Heavy Alcohol Use Worsens Disease Progression in Women with Chronic Hepatitis C

By Liz Highleyman

It is well known that heavy alcohol use can cause liver damage on its own. It also accelerates liver disease progression in people with hepatitis C virus (HCV) infection and interferes with response to hepatitis C therapy.

As reported in the February 2007 issue of Alcoholism Clinical & Experimental Research, investigators conducted a study to assess outcomes, including mortality, associated with alcohol use among HCV-infected individuals in the United States.

They obtained information from 7,263,163 U.S. death records from 2000 to 2002 drawn from the Multiple Cause of Death public-use data files compiled by the National Center for Health Statistics. International Classification of Diseases, Tenth Revision (ICD-10) codes were used to identify the presence of HCV and heavy alcohol use (as indicated by alcohol-induced medical conditions), either as the underlying cause or as one of the contributing causes of death.

Deaths were divided into 4 cause-of-death categories:

• HCV without heavy alcohol use;
• Heavy alcohol use without HCV;
• HCV plus heavy alcohol use;
• all others.

The mean ages of death and the cumulative probabilities of death derived from multiple-cause life tables were compared across these categories.

Results

• HCV, heavy alcohol use, or both were factors in 132,468 deaths.

• Individuals with HCV-related deaths showed an excessive prevalence of heavy alcohol use compared with non-HCV deaths.

• Compared with HCV-related deaths without heavy alcohol use, the mean age at death decreased for deaths due to HCV plus heavy alcohol use:

- from 55.1 to 50.0 years among men;
- from 61.0 to 49.1 years among women.

• The cumulative probability of death before age 65 was higher for individuals with HCV plus heavy alcohol use, compared with HCV alone:

- 91% vs 68% among men;
- 88% vs 47% among women.

Conclusion

"This study provides mortality-based evidence to further establish heavy alcohol consumption as one of the key risk factors contributing to premature deaths from HCV in the United States," the authors concluded. "More importantly, this study, for the first time, presents empirical evidence that alcohol consumption affects men and women differently in HCV mortality."

"While HCV alone demonstrated a disproportionate effect on premature death in males, heavy alcohol use presented a stronger effect in females, resulting in a "catching-up" effect that diminished the gender difference in age of HCV death," they wrote.

In general, women with HCV experience slower liver disease progression and longer survival than HCV-infected men, but this study shows that this advantage can be lost with heavy alcohol use.

02/20/07

Reference
C M Chen, Y H Yoon, H Y Yi, and others. Alcohol and hepatitis C mortality among males and females in the United States: a life table analysis. Alcoholism Clinical & Experimental Research 31(2): 285-292. February 2007.