1% of US deaths related to viral hepatitis

People with HBV or HCV dying on average 22 to 23 years earlier

Michael Carter
Published:
30 September 2013

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.”

Reference

Ly KN et al. Causes of death and characteristics of decedents with viral hepatitis, United States, 2010. Clin Infect Dis, online edition, 2013.