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Hepatitis B and C Reduce Survival by More than 20 Years

People with chronic hepatitis B or C lived about 2 decades less on average than those who did not have these infections, and chronic viral hepatitis was the 15th leading cause of death in the U.S. in 2010, CDC researchers reported in the January 1, 2014, issue of Clinical Infectious Diseases.

Over years or decades, chronic hepatitis B or C can progress to severe liver disease including cirrhosis or hepatocellular carcinoma, which can lead to end-stage liver failure, transplantation, or liver-related death. Previous research has shown that the burden of mortality due to viral hepatitis is growing in the U.S., particularly among "Baby Boomers" born between 1945 and 1965, and chronic viral hepatitis is now a leading cause of death in the U.S. and worldwide.

Kathleen Ly and colleagues from the Centers for Disease Control and Prevention's Division of Viral Hepatitis looked at demographic characteristics and most frequent causes of death among people with viral hepatitis.

This cross-sectional study analyzed approximately 2.4 million death records using the 2010 U.S. multiple cause of death data file, which contains information on all registered deaths occurring within the calendar year. State vital registry offices collect death certificates and share the information with the National Center for Health Statistics, which uses it to generate annual national multiple-cause mortality datasets.

The researchers calculated mortality rates for decedents (people who died) with and without hepatitis A, B, and C, and relative risks for the most frequently cited conditions in decedents with and without hepatitis B and C.

Results

• During 2010 there were a total of 18,473 deaths (0.7%) with hepatitis A, B, or C listed among the causes of death.
• 90% of these deaths listed hepatitis C.
• These deaths occurred disproportionately among people in the 45-64 age group (about three-quarters of such deaths).
• Among people who died of the same primary causes, decedents with hepatitis B or C listed as an additional cause died, on average, 22-23 years earlier than decedents who did not have these infections listed.
• People age 45-65 who died with hepatitis B or C had an increased likelihood of having the following conditions reported:

o   Liver or bile duct cancer;

o   Liver fibrosis, cirrhosis, and other liver diseases;

o   Alcohol-related liver disease;

o   Gastrointestinal hemorrhage;

o   HIV infection;

o   Acute and unspecified kidney failure;

o   Septicemia (for hepatitis C only).

"Decedents with other causes of death that include HBV or HCV died 22-23 years earlier than decedents not listing these infections," the study authors concluded. "These data suggest and support the need for prevention, early identification, and treatment of HBV and HCV."

"If ranked as a leading cause of death using NCHS’s list, viral hepatitis would rank as the 15th leading cause of death," they noted.

"Hepatitis C alone was identified as a cause of nearly 90% of these deaths; the majority of those occurred in persons aged 45-64 years," they wrote in their discussion. This supports the CDC's 2012 recommendation that everyone born between 1945 and 1965 should be screened for HCV at least once.

Moreover, they added, "the well-demonstrated increased mortality of both liver-associated and non-liver-associated conditions in HBV- and HCV-infected decedents provides key evidence to get more people treated before they develop serious illness" -- a recommendation that will be more urgent now that direct-acting oral drugs are able to cure most people with chronic hepatitis C in 3-6 months or less without interferon.

"Our study demonstrated racial/ethnic disparities in deaths with hepatitis C, specifically among American Indians/Alaskan Natives, non-Hispanic blacks, and Hispanics," they wrote. "While health disparities in minorities with chronic HCV infection have been documented since as early as 1999, we and others showed that this trend, unfortunately, has not improved."

In summary, the researchers recommended based on these findings, "prevention efforts should be expanded to further (1) promote hepatitis A and B vaccination among recommended target groups, (2) increase hepatitis B and C screening to get more people into care and earlier treatment, and (3) treat alcohol- and drug-related disorders."

12/23/13

Reference

KN Ly, J Xing, RM Klevens, et al. Causes of Death and Characteristics of Decedents With Viral Hepatitis, United States, 2010. Clinical Infectious Diseases 58(1):40-49. January 1, 2014.