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HCV mortality rates in US increased significantly between 2003 and 2013

Michael Carter
15 March 2016

There was a significant increase in hepatitis C virus (HCV)-related mortality in the United States between 2003 and 2013, investigators report in the online edition of Clinical Infectious Diseases. Each year, there was a 6% increase in the number of HCV-related deaths. At the same time, the number of deaths associated with other infectious disease, including HIV, fell significantly.

“The increasing HCV-associated mortality trend underscores the urgency of finding, evaluating and treating patients,” comment the authors.

Estimates suggest that between 2 and 3 million individuals in the US are living with HCV infection and research suggests that a majority of these patients are unaware of their status. New all-oral therapies are able to cure HCV in most patients, but the burden of illness and death associated with the disease has been underappreciated. A team of investigators therefore used data from the National Center for Health Statistics to analyse trends in HCV-related mortality between 2003 and 2013. These trends were compared to those for other infectious diseases, including HIV, pneumococcal disease and tuberculosis (TB). The investigators also calculated age-adjusted annual mortality rates for HCV and compared these to data for other infectious causes.

The annual number of HCV-related deaths increased from 11,051 in 2003 to 19,368 in 2013. The number of deaths increased by an average of 865 per year, a significant annual percentage increase of 6% (p < 0.05).

In comparison, the number of annual deaths associated with other infectious causes declined from 24,745 in 2003 to 17,915 in 2013. Each year, the number of deaths fell by an average of 718, an annual percentage decrease of 3% (p < 0.05). The decline in deaths attributable to other infectious diseases was mainly driven by a marked fall in HIV-related mortality, and to a lesser extent deaths associated with pneumococcal disease and TB. Taken together, the number of deaths associated with these conditions fell from 17,764 in 2003 to 10,683 in 2013, a 40% decrease. The number of HIV-related deaths declined by 42%, from 15,168 deaths in 2003 to 8,831 deaths in 2013.

In 2012, the number of HCV-related deaths for the first time exceeded the total number of deaths associated with 60 other infectious causes.

The HCV-related mortality rate increased from 3.72 deaths per 100,000 population in 2003 to 5.03 deaths per 100,000 population in 2013. These data represent an annual increase of 0.14 deaths per 100,000 population, or a 3% annual increase.

Mortality rates associated with other infectious conditions fell from 8.51 deaths per 100,000 population to 5.25 deaths per 100,000 population. The mortality rate fell by an average of 0.34 deaths per 100,000 population, and the annual percentage fall was 5%.

Over the ten years of analysis, 51% of all HCV-associated deaths involved patients aged between 55 and 64 years.

“Despite improving therapies, our study found that deaths associated with HCV continued to rise,” comment the investigators. “The great decline in deaths associated with HIV, pneumococcal disease and tuberculosis…were likely due to implementation of effective public health programs and policies.”

If anything, the authors believe their findings under-estimate the true scale of HCV-related mortality in the US.

They believe there are a number of reasons why services to support HCV surveillance, testing, linkage to care and treatment are not fully supported. These include:

  • The long period of asymptomatic disease, which leads both patients and healthcare professionals to discount the importance of HCV infection
  • Lack of cohesive patient advocacy
  • “Compassion fatigue” caused by HIV and other public health problems
  • A “nihilism” about the perceived cost of new curative therapies.

“The unabated increasing trend in the number of hepatitis C-related deaths documented from 1999-2013, predominately among middle-aged persons, underscores the urgency of finding, evaluating, and treating patients in the largest infectious disease epidemic in the United States,” conclude the authors.


Ly KN. Rising mortality associated with hepatitis C in the United States, 2003-2013. Clin Infect Dis, online edition, 2016.