Viral hepatitis
was associated with approximately 1% of deaths in the US in 2010, research
published in the online edition of Clinical
Infectious Diseases demonstrates. The burden of mortality associated with
hepatitis B virus (HBV) and hepatitis C virus (HCV) infection was greatest in
people aged between 55 and 65 years, the so-called “baby boom” generation.
Analysis of the top-ten causes of death
showed that individuals with HBV or HCV infection dying of these causes were
dying between 22 and 23 years earlier than uninfected individuals.
“In 2012, the
Centers for Disease Control and Prevention recommended one-time hepatitis C
testing for persons born during 1945-1965 (aged 45-65 years in 2010),” note the
authors. “Our study provides evidence that strengthens this national
recommendation, and moreover, 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.”
It is already well
known that the number of deaths associated with HBV and HCV infection in the US
is growing. Investigators wanted to establish a clearer understanding of the
proportion of deaths associated with viral hepatitis, and also the demographic
characteristics of people dying of these infections and the co-morbidities
associated with these deaths.
They therefore
analysed data for the approximately 2,500,000 deaths recorded in the US in
2010. This showed that 18,473 (0.7%) of deaths listed hepatitis A (HAV), HBV or
HCV among the causes of death. The age-adjusted viral hepatitis mortality rate
was 5.2 deaths per 100,000 population.
HAV was listed as
the underlying cause of death in 30 deaths and as any cause of death in 96
cases. HBV was the underlying cause of death in 589 (0.02%) people and was
listed as any cause of death in 1875 cases (0.08%). HCV was the documented
underlying cause of death for 6857 (0.28%) deaths and as any cause of death in 17,113
deaths (0.69%).
Of the deaths
associated with viral hepatitis, 93% involved HCV, 10% HBV and 0.5% HAV. Some
3% of HCV-related deaths also involved HBV or HAV infection and 2% of people
dying of HBV also had HAV infection. The investigators believe this finding
shows the importance of targeted vaccination campaigns against HBV and HAV.
Among people
dying with HBV, the highest mortality rates were observed among people aged
between 55 and 65 years, Asians/Pacific Islanders and males.
For people dying
with HCV, the highest mortality rates were also among the 55 to 65 age group,
as well as American Indians/Alaskan natives, black and Hispanic ethnic
groups and males.
In comparison, the
highest mortality rates of people dying without viral hepatitis were among
patients aged over 75 years.
Liver disease
(fibrosis, cirrhosis and other liver complications) was the most frequently
listed cause of death among people with HBV and HCV (45% and 48%,
respectively).
Cancer of the
liver and alcohol-related liver disease was cited in 12% of HBV deaths and 23%
of HCV deaths.
The most
frequently cited non-liver associated conditions were cardiac arrest,
substance-related disorders, diabetes mellitus, hypertension (high blood pressure) and respiratory
arrest (9 to 14%). Septicaemia was among the top-ten causes of death for
people with HCV but not HBV.
Liver associated
conditions were not among the leading causes of death for people who died
without HBV or HCV infection.
Analysis of all
patients dying with the ten most frequently cited causes, showed that deaths
involving HBV or HCV occurred on average 22 to 23 years younger than deaths not
listing viral hepatitis.
“Prevention and
early treatment of hepatitis B and C will prevent these early deaths,” write
the authors.
“Vital hepatitis
was listed as a cause of more than 18,000 recorded US deaths in 2010, and there
are many who are likely not diagnosed or recorded as having these hepatitides,”
conclude the authors. They believe their findings have immediate clinical
significance: “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.”