Hamish Innes1,2, Sharon J Hutchinson1,2, Niels Obel3, Peer B Christensen4, Esther J Aspinall1,2, David Goldberg1,2, Henrik Krarup5, Scott A McDonald1,2, Allan McLeod2, Amanda Weir6, Lars H Omland3. 1. School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK. 2. Health Protection Scotland, Blood borne viruses and STIs, Glasgow, UK. 3. Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. 4. Department of Infectious Diseases, Odense University Hospital, Odense, Denmark. 5. Section of Molecular Diagnostics, Clinical Biochemistry, Aalborg University Hospital, Aalborg Hospital, Aalborg, Denmark. 6. NHS, National Services Scotland, Edinburgh, UK.
Abstract
UNLABELLED: Liver mortality among individuals with chronic hepatitis C (CHC) infection is common, but the relative contribution of CHC per se versus adverse health behaviors is uncertain. We explored data on spontaneous resolvers of hepatitis C virus (HCV) as a benchmark group to uncover the independent contribution of CHC on liver mortality. Using national HCV diagnosis and mortality registers from Denmark and Scotland, we calculated the liver mortality rate (LMR) for persons diagnosed with CHC infection (LMRchronic ) and spontaneously resolved infection (LMRresolved ), according to subgroups defined by age, sex, and drug use. Through these mortality rates, we determined subgroup-specific attributable fractions (AFs), defined as (LMRchronic - LMRresolved )/LMRchronic , and then calculated the total attributable fraction (TAF) as a weighted average of these AFs. Thus, the TAF represents the overall fraction (where 0.00 = not attributable at all; and 1.00 = entirely attributable) of liver mortality attributable to CHC in the diagnosed population. Our cohort comprised 7,005 and 21,729 persons diagnosed with HCV antibodies in Denmark and Scotland, respectively. Mean follow-up duration was 6.3-6.9 years. The TAF increased stepwise with age. It was lowest for death occurring at <45 years of age (0.21 in Denmark; 0.26 in Scotland), higher for death occurring at 45-59 years (0.69 in Denmark; 0.69 in Scotland), and highest for death at 60+years (0.92 in Denmark; 0.75 in Scotland). Overall, the TAF was 0.66 (95% confidence interval [CI]: 0.55-0.78) in Denmark and 0.55 (95% CI: 0.44-0.66) in Scotland. CONCLUSIONS: In Denmark and Scotland, the majority of liver death in the CHC-diagnosed population can be attributed to CHC-nevertheless, an appreciable fraction cannot, cautioning that liver mortality in this population is a compound problem that can be reduced, but not solved, through antiviral therapy alone.
UNLABELLED: Liver mortality among individuals with chronic hepatitis C (CHC) infection is common, but the relative contribution of CHC per se versus adverse health behaviors is uncertain. We explored data on spontaneous resolvers of hepatitis C virus (HCV) as a benchmark group to uncover the independent contribution of CHC on liver mortality. Using national HCV diagnosis and mortality registers from Denmark and Scotland, we calculated the liver mortality rate (LMR) for persons diagnosed with CHC infection (LMRchronic ) and spontaneously resolved infection (LMRresolved ), according to subgroups defined by age, sex, and drug use. Through these mortality rates, we determined subgroup-specific attributable fractions (AFs), defined as (LMRchronic - LMRresolved )/LMRchronic , and then calculated the total attributable fraction (TAF) as a weighted average of these AFs. Thus, the TAF represents the overall fraction (where 0.00 = not attributable at all; and 1.00 = entirely attributable) of liver mortality attributable to CHC in the diagnosed population. Our cohort comprised 7,005 and 21,729 persons diagnosed with HCV antibodies in Denmark and Scotland, respectively. Mean follow-up duration was 6.3-6.9 years. The TAF increased stepwise with age. It was lowest for death occurring at <45 years of age (0.21 in Denmark; 0.26 in Scotland), higher for death occurring at 45-59 years (0.69 in Denmark; 0.69 in Scotland), and highest for death at 60+years (0.92 in Denmark; 0.75 in Scotland). Overall, the TAF was 0.66 (95% confidence interval [CI]: 0.55-0.78) in Denmark and 0.55 (95% CI: 0.44-0.66) in Scotland. CONCLUSIONS: In Denmark and Scotland, the majority of liver death in the CHC-diagnosed population can be attributed to CHC-nevertheless, an appreciable fraction cannot, cautioning that liver mortality in this population is a compound problem that can be reduced, but not solved, through antiviral therapy alone.
Authors: Nadine Kronfli; Sahir R Bhatnagar; Mark W Hull; Erica E M Moodie; Joseph Cox; Sharon Walmsley; John Gill; Curtis Cooper; Valérie Martel-Laferrière; Neora Pick; Marina B Klein Journal: AIDS Date: 2019-05-01 Impact factor: 4.177
Authors: Matthew Hickman; John F Dillon; Lawrie Elliott; Daniela De Angelis; Peter Vickerman; Graham Foster; Peter Donnan; Ann Eriksen; Paul Flowers; David Goldberg; William Hollingworth; Samreen Ijaz; David Liddell; Sema Mandal; Natasha Martin; Lewis J Z Beer; Kate Drysdale; Hannah Fraser; Rachel Glass; Lesley Graham; Rory N Gunson; Emma Hamilton; Helen Harris; Magdalena Harris; Ross Harris; Ellen Heinsbroek; Vivian Hope; Jeremy Horwood; Sarah Karen Inglis; Hamish Innes; Athene Lane; Jade Meadows; Andrew McAuley; Chris Metcalfe; Stephanie Migchelsen; Alex Murray; Gareth Myring; Norah E Palmateer; Anne Presanis; Andrew Radley; Mary Ramsay; Pantelis Samartsidis; Ruth Simmons; Katy Sinka; Gabriele Vojt; Zoe Ward; David Whiteley; Alan Yeung; Sharon J Hutchinson Journal: BMJ Open Date: 2019-09-24 Impact factor: 2.692