Mortality in hepatitis C patients who achieve a sustained viral response compared to the general population

Hamish Innes; Scott McDonald; Peter Hayes; John F Dillon; Sam Allen; David Goldberg; Peter R Mills; Stephen T Barclay; David Wilks; Heather Valerio; Ray Fox; Diptendu Bhattacharyya; Nicholas Kennedy; Judith Morris; Andrew Fraser; Adrian Stanley; Peter Bramley; Sharon J Hutchinson

doi:10.1016/j.jhep.2016.08.004

Mortality in hepatitis C patients who achieve a sustained viral response compared to the general population

Hamish Innes (Lead / Corresponding author), Scott McDonald, Peter Hayes, John F Dillon, Sam Allen, David Goldberg, Peter R Mills, Stephen T Barclay, David Wilks, Heather Valerio, Ray Fox, Diptendu Bhattacharyya, Nicholas Kennedy, Judith Morris, Andrew Fraser, Adrian Stanley, Peter Bramley, Sharon J Hutchinson

Research output: Contribution to journal › Article › peer-review

44 Citations (Scopus)

329 Downloads (Pure)

Abstract

Background: The number of people living with previous hepatitis-C infection that have attained a sustained viral response (SVR) is expected to grow rapidly. So far, the prognosis of this group relative to the general population is unclear.

Methods: Individuals attaining SVR in Scotland in 1996-2011 were identified using a national database. Through record-linkage, we obtained cause-specific mortality data complete to Dec 2013. We calculated standardised-mortality-ratios (SMRs) to compare the frequency of mortality in SVR patients to the general population. In a parallel analysis, we used Cox regression to identify modifiable patient characteristics associated with post-SVR mortality.

Results: We identified 1824 patients, followed on average for 5.2 years after SVR. In total, 78 deaths were observed. Overall, all-cause mortality was 1.9 times more frequent for SVR patients than the general population (SMR: 1.86; 95% CI:1.49-2.32). Significant cause-specific elevations were seen for death due to primary liver cancer (SMR: 23.50; 95% CI:12.23-45.16), and death due to drug-related causes (SMR: 6.58, 95%CI:4.15-10.45). Together these two causes accounted for 66% of the total excess death observed. All of the modifiable characteristics associated with increased mortality were markers either of heavy alcohol use or injecting drug use. Individuals without these behavioural markers (32.8% of cohort) experienced equivalent survival to the general population (SMR: 0.70; 95% CI:0.41-1.18) CONCLUSIONS: Mortality in Scottish SVR patients is higher overall than the general population. The excess was driven by death from drug-related causes and liver cancer. Health risk behaviours emerged as important modifiable determinants of mortality in this population.

Lay summary: Patients cured of hepatitis C through treatment had a higher mortality rate overall than the general population. Most of the surplus mortality was due to drug-related causes and death from liver cancer. A history of heavy alcohol use and injecting drug use were associated with a higher mortality risk.

Original language	English
Pages (from-to)	19-27
Number of pages	9
Journal	Journal of Hepatology
Volume	66
Issue number	1
Early online date	18 Aug 2016
DOIs	https://doi.org/10.1016/j.jhep.2016.08.004
Publication status	Published - Jan 2017

Keywords

Excess mortality
Hepatitis C
Cure
Epidemiology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.jhep.2016.08.004

Author Accepted Manuscript
© 2016. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
Accepted author manuscript, 1.21 MBLicence: CC BY-NC-ND

Dillon, John
- Respiratory Medicine and Gastroenterology - Clinical Professor (Teaching and Research) of Hepatology and Gastroenterology
Person: Academic

Cite this

Innes, H., McDonald, S., Hayes, P., Dillon, J. F., Allen, S., Goldberg, D., Mills, P. R., Barclay, S. T., Wilks, D., Valerio, H., Fox, R., Bhattacharyya, D., Kennedy, N., Morris, J., Fraser, A., Stanley, A., Bramley, P., & Hutchinson, S. J. (2017). Mortality in hepatitis C patients who achieve a sustained viral response compared to the general population. Journal of Hepatology, 66(1), 19-27. https://doi.org/10.1016/j.jhep.2016.08.004

@article{a121d79bd6294424ab80e484e1a5a8db,

title = "Mortality in hepatitis C patients who achieve a sustained viral response compared to the general population",

abstract = "Background: The number of people living with previous hepatitis-C infection that have attained a sustained viral response (SVR) is expected to grow rapidly. So far, the prognosis of this group relative to the general population is unclear.Methods: Individuals attaining SVR in Scotland in 1996-2011 were identified using a national database. Through record-linkage, we obtained cause-specific mortality data complete to Dec 2013. We calculated standardised-mortality-ratios (SMRs) to compare the frequency of mortality in SVR patients to the general population. In a parallel analysis, we used Cox regression to identify modifiable patient characteristics associated with post-SVR mortality.Results: We identified 1824 patients, followed on average for 5.2 years after SVR. In total, 78 deaths were observed. Overall, all-cause mortality was 1.9 times more frequent for SVR patients than the general population (SMR: 1.86; 95% CI:1.49-2.32). Significant cause-specific elevations were seen for death due to primary liver cancer (SMR: 23.50; 95% CI:12.23-45.16), and death due to drug-related causes (SMR: 6.58, 95%CI:4.15-10.45). Together these two causes accounted for 66% of the total excess death observed. All of the modifiable characteristics associated with increased mortality were markers either of heavy alcohol use or injecting drug use. Individuals without these behavioural markers (32.8% of cohort) experienced equivalent survival to the general population (SMR: 0.70; 95% CI:0.41-1.18) CONCLUSIONS: Mortality in Scottish SVR patients is higher overall than the general population. The excess was driven by death from drug-related causes and liver cancer. Health risk behaviours emerged as important modifiable determinants of mortality in this population.Lay summary: Patients cured of hepatitis C through treatment had a higher mortality rate overall than the general population. Most of the surplus mortality was due to drug-related causes and death from liver cancer. A history of heavy alcohol use and injecting drug use were associated with a higher mortality risk.",

keywords = "Excess mortality, Hepatitis C, Cure, Epidemiology",

author = "Hamish Innes and Scott McDonald and Peter Hayes and Dillon, {John F} and Sam Allen and David Goldberg and Mills, {Peter R} and Barclay, {Stephen T} and David Wilks and Heather Valerio and Ray Fox and Diptendu Bhattacharyya and Nicholas Kennedy and Judith Morris and Andrew Fraser and Adrian Stanley and Peter Bramley and Hutchinson, {Sharon J}",

note = "Funding from the Scottish Government.",

year = "2017",

month = jan,

doi = "10.1016/j.jhep.2016.08.004",

language = "English",

volume = "66",

pages = "19--27",

journal = "Journal of Hepatology",

issn = "0168-8278",

publisher = "Elsevier",

number = "1",

}

Innes, H, McDonald, S, Hayes, P, Dillon, JF, Allen, S, Goldberg, D, Mills, PR, Barclay, ST, Wilks, D, Valerio, H, Fox, R, Bhattacharyya, D, Kennedy, N, Morris, J, Fraser, A, Stanley, A, Bramley, P & Hutchinson, SJ 2017, 'Mortality in hepatitis C patients who achieve a sustained viral response compared to the general population', Journal of Hepatology, vol. 66, no. 1, pp. 19-27. https://doi.org/10.1016/j.jhep.2016.08.004

TY - JOUR

T1 - Mortality in hepatitis C patients who achieve a sustained viral response compared to the general population

AU - Innes, Hamish

AU - McDonald, Scott

AU - Hayes, Peter

AU - Dillon, John F

AU - Allen, Sam

AU - Goldberg, David

AU - Mills, Peter R

AU - Barclay, Stephen T

AU - Wilks, David

AU - Valerio, Heather

AU - Fox, Ray

AU - Bhattacharyya, Diptendu

AU - Kennedy, Nicholas

AU - Morris, Judith

AU - Fraser, Andrew

AU - Stanley, Adrian

AU - Bramley, Peter

AU - Hutchinson, Sharon J

N1 - Funding from the Scottish Government.

PY - 2017/1

Y1 - 2017/1

N2 - Background: The number of people living with previous hepatitis-C infection that have attained a sustained viral response (SVR) is expected to grow rapidly. So far, the prognosis of this group relative to the general population is unclear.Methods: Individuals attaining SVR in Scotland in 1996-2011 were identified using a national database. Through record-linkage, we obtained cause-specific mortality data complete to Dec 2013. We calculated standardised-mortality-ratios (SMRs) to compare the frequency of mortality in SVR patients to the general population. In a parallel analysis, we used Cox regression to identify modifiable patient characteristics associated with post-SVR mortality.Results: We identified 1824 patients, followed on average for 5.2 years after SVR. In total, 78 deaths were observed. Overall, all-cause mortality was 1.9 times more frequent for SVR patients than the general population (SMR: 1.86; 95% CI:1.49-2.32). Significant cause-specific elevations were seen for death due to primary liver cancer (SMR: 23.50; 95% CI:12.23-45.16), and death due to drug-related causes (SMR: 6.58, 95%CI:4.15-10.45). Together these two causes accounted for 66% of the total excess death observed. All of the modifiable characteristics associated with increased mortality were markers either of heavy alcohol use or injecting drug use. Individuals without these behavioural markers (32.8% of cohort) experienced equivalent survival to the general population (SMR: 0.70; 95% CI:0.41-1.18) CONCLUSIONS: Mortality in Scottish SVR patients is higher overall than the general population. The excess was driven by death from drug-related causes and liver cancer. Health risk behaviours emerged as important modifiable determinants of mortality in this population.Lay summary: Patients cured of hepatitis C through treatment had a higher mortality rate overall than the general population. Most of the surplus mortality was due to drug-related causes and death from liver cancer. A history of heavy alcohol use and injecting drug use were associated with a higher mortality risk.

AB - Background: The number of people living with previous hepatitis-C infection that have attained a sustained viral response (SVR) is expected to grow rapidly. So far, the prognosis of this group relative to the general population is unclear.Methods: Individuals attaining SVR in Scotland in 1996-2011 were identified using a national database. Through record-linkage, we obtained cause-specific mortality data complete to Dec 2013. We calculated standardised-mortality-ratios (SMRs) to compare the frequency of mortality in SVR patients to the general population. In a parallel analysis, we used Cox regression to identify modifiable patient characteristics associated with post-SVR mortality.Results: We identified 1824 patients, followed on average for 5.2 years after SVR. In total, 78 deaths were observed. Overall, all-cause mortality was 1.9 times more frequent for SVR patients than the general population (SMR: 1.86; 95% CI:1.49-2.32). Significant cause-specific elevations were seen for death due to primary liver cancer (SMR: 23.50; 95% CI:12.23-45.16), and death due to drug-related causes (SMR: 6.58, 95%CI:4.15-10.45). Together these two causes accounted for 66% of the total excess death observed. All of the modifiable characteristics associated with increased mortality were markers either of heavy alcohol use or injecting drug use. Individuals without these behavioural markers (32.8% of cohort) experienced equivalent survival to the general population (SMR: 0.70; 95% CI:0.41-1.18) CONCLUSIONS: Mortality in Scottish SVR patients is higher overall than the general population. The excess was driven by death from drug-related causes and liver cancer. Health risk behaviours emerged as important modifiable determinants of mortality in this population.Lay summary: Patients cured of hepatitis C through treatment had a higher mortality rate overall than the general population. Most of the surplus mortality was due to drug-related causes and death from liver cancer. A history of heavy alcohol use and injecting drug use were associated with a higher mortality risk.

KW - Excess mortality

KW - Hepatitis C

KW - Cure

KW - Epidemiology

U2 - 10.1016/j.jhep.2016.08.004

DO - 10.1016/j.jhep.2016.08.004

M3 - Article

C2 - 27545496

SN - 0168-8278

VL - 66

SP - 19

EP - 27

JO - Journal of Hepatology

JF - Journal of Hepatology

IS - 1

ER -

Mortality in hepatitis C patients who achieve a sustained viral response compared to the general population

Abstract

Keywords

UN SDGs

Access to Document

Fingerprint

Profiles

Dillon, John

Cite this