Mel Krajden1, Darrel A Cook2, Stanley Wong2, Amanda Yu2, Zahid A Butt3, Carmine Rossi2, Maryam Darvishian3, Maria Alvarez2, Jane A Buxton3, Mark Tyndall3, Naveed Z Janjua3. 1. Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada; Dept. of Pathology & Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. Electronic address: mel.krajden@bccdc.ca. 2. Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada. 3. Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Abstract
BACKGROUND: Persons with hepatitis C virus (HCV) infection are at risk of mortality from both chronic liver disease and HCV acquisition risk activities. We compared causes of death among HCV positive and negative individuals to characterize contributions of acquisition risks and viral sequelae. METHODS: The British Columbia (BC) Hepatitis Testers Cohort (BC-HTC) includes all individuals tested for HCV or reported as a HCV case since 1992, linked to health administrative data. ICD-10 codes were used to classify deaths as: 1) liver-related (LR); 2) HCV acquisition risk-related (AR); and 3) other causes. Mortality proportions and trends were assessed among HCV positive and negative individuals overall and by birth cohort (born <1945, 1945-64 and ≥1965). RESULTS: As of December 31, 2018, of 1,300,204 HCV-tested individuals, 20,049 (27.5%) HCV positive and 132,999 (10.2%) HCV negative individuals had died (median age at death: 56.4 vs. 74.5 years, respectively). HCV positive individuals were more likely than negatives to die from both AR (24.7%/4.2%) and LR (23.4%/6.2%) causes. Deaths among older HCV positive individuals were more likely to be LR while younger individuals were more likely AR: 1) birth cohort <1945 (25.3%/2.7%); 2) 1945-64 (26.5%/23.7%) and ≥1965 (7.7%/59.9%). Among HCV positives, LR mortality increased from 1992 to 2014, then declined sharply, coinciding with the introduction and uptake of direct-acting antiviral drugs. AR mortality increased from 1992 to 2000, declined slowly until 2013, then rapidly increased, coinciding with the recent surge in opioid overdose deaths. CONCLUSIONS: Curative HCV treatments reduce LR mortality, but typically will not impact AR mortality. This will need to be addressed if the World Health Organization 2030 HCV mortality reduction goals are to be achieved.
BACKGROUND:Persons with hepatitis C virus (HCV) infection are at risk of mortality from both chronic liver disease and HCV acquisition risk activities. We compared causes of death among HCV positive and negative individuals to characterize contributions of acquisition risks and viral sequelae. METHODS: The British Columbia (BC) Hepatitis Testers Cohort (BC-HTC) includes all individuals tested for HCV or reported as a HCV case since 1992, linked to health administrative data. ICD-10 codes were used to classify deaths as: 1) liver-related (LR); 2) HCV acquisition risk-related (AR); and 3) other causes. Mortality proportions and trends were assessed among HCV positive and negative individuals overall and by birth cohort (born <1945, 1945-64 and ≥1965). RESULTS: As of December 31, 2018, of 1,300,204 HCV-tested individuals, 20,049 (27.5%) HCV positive and 132,999 (10.2%) HCV negative individuals had died (median age at death: 56.4 vs. 74.5 years, respectively). HCV positive individuals were more likely than negatives to die from both AR (24.7%/4.2%) and LR (23.4%/6.2%) causes. Deaths among older HCV positive individuals were more likely to be LR while younger individuals were more likely AR: 1) birth cohort <1945 (25.3%/2.7%); 2) 1945-64 (26.5%/23.7%) and ≥1965 (7.7%/59.9%). Among HCV positives, LR mortality increased from 1992 to 2014, then declined sharply, coinciding with the introduction and uptake of direct-acting antiviral drugs. AR mortality increased from 1992 to 2000, declined slowly until 2013, then rapidly increased, coinciding with the recent surge in opioid overdose deaths. CONCLUSIONS: Curative HCV treatments reduce LR mortality, but typically will not impact AR mortality. This will need to be addressed if the World Health Organization 2030 HCV mortality reduction goals are to be achieved.
Authors: Jiafeng Li; Julia L Casey; Zoë R Greenwald; Abdool S Yasseen Iii; Melisa Dickie; Jordan J Feld; Curtis L Cooper; Angela M Crawley Journal: Can Liver J Date: 2021-02-24
Authors: Zahid A Butt; Stanley Wong; Carmine Rossi; Mawuena Binka; Jason Wong; Amanda Yu; Maryam Darvishian; Maria Alvarez; Nuria Chapinal; Geoff Mckee; Mark Gilbert; Mark W Tyndall; Mel Krajden; Naveed Z Janjua Journal: Open Forum Infect Dis Date: 2020-08-13 Impact factor: 3.835
Authors: Maryam Darvishian; Zahid A Butt; Stanley Wong; Eric M Yoshida; Jaskaran Khinda; Michael Otterstatter; Amanda Yu; Mawuena Binka; Carmine Rossi; Geoff McKee; Margo Pearce; Maria Alvarez; Jason Wong; Darrel Cook; Troy Grennan; Jane Buxton; Mark Tyndall; Ryan Woods; Mel Krajden; Parveen Bhatti; Naveed Z Janjua Journal: Ther Adv Med Oncol Date: 2021-02-11 Impact factor: 8.168
Authors: Sofia R Bartlett; Stanley Wong; Amanda Yu; Margo Pearce; Julia MacIsaac; Susan Nouch; Prince Adu; James Wilton; Hasina Samji; Emilia Clementi; Hector Velasquez; Dahn Jeong; Mawuena Binka; Maria Alvarez; Jason Wong; Jane Buxton; Mel Krajden; Naveed Z Janjua Journal: Clin Infect Dis Date: 2022-03-01 Impact factor: 20.999