Burden of disease related to hepatitis C and hepatitis B in Spain: a methodological challenge of an unfolding health problem

Abstract

Most previous studies of burden of disease (BoD) in the area of transmissible diseases have assessed the burden of hepatitis C and B without including the end stages of the disease and using an incident approach. We aimed to assess the disability-adjusted life years (DALYs) related to hepatitis C and B in Spain in 2006 taking into account related cirrhosis and liver cancer. A prevalence approach was used to estimate current years lived with disability (YLD) because of viral hepatitis contracted years/decades before. We added years of life lost (YLL) to obtain DALYs. Around 76,000 DALYs were attributed to hepatitis C virus (HCV) and 15,323 to hepatitis B virus (HBV) when calculated without applying social values. Applying the discount rate and age-weighting used in the Global Burden Disease study, the BoD nearly halved. In any case, the burden related to hepatitis C including long-term outputs becomes the leading cause of DALYs among transmissible diseases in Spain. The mortality component (YLL) represents more than 90% of the BoD in both HCV and HBV. The findings emphasize the need to provide good surveillance systems not only concerning acute viral hepatitis, but also chronic and end-stage consequences to allow a reliable assessment of the prevention and public health control policies.

The burden of hepatitis C infection in a Southern Brazilian State

“…Some studies have estimated the burden of disease associated with hepatitis C. In Spain, about 76,000 disability-adjusted life years (DALY) were estimated for the year 2006 6 . In Europe, about 1.2 million DALY were attributed to HCV in 2002, which corresponded to a rate of 135.5 DALY per 100,000 population.…”

“…For the categorization of estimated cases of hepatitis C according to the clinical condition, the parameters of the study on the burden of viral hepatitis carried out in Spain were used 6 . In that study, 60% of the cases of hepatocellular carcinoma were attributed to hepatitis C. To estimate the number of hepatocellular carcinoma cases in Santa Catarina, the records of population-based cancer incidence in Florianópolis, the capital City, for the year 2008 were used: an incidence of 5.3 cases per 100,000 for women and 9.75 cases per 100,000 for men 10 , which totaled 163 and 297 cases, respectively.…”

“…Cirrhosis cases were categorized into compensated and decompensated conditions. Twenty percent of the cases of cirrhosis were attributed to decompensated liver disease 6 .…”

Hepatitis crónicas virales B y C en población inmigrante en España

“…La mayoría de las enfermedades infecciosas típicas de los inmigrantes no tienen impacto, en términos de salud pública, en el país de destino, ya que su transmisión es muy difícil, bien por la falta de vector o de hospedadores intermediarios 30 . Sin embargo, las hepatitis virales crónicas merecen una especial consideración tanto por la carga de enfermedad que supone en años de vida perdidos por discapacidad y muerte prematura como por su coste para el sistema sanitario 1,6,[31][32][33] . En este sentido, debe considerarse el impacto que la población inmigrante pueda tener en el aumento de estas enfermedades en nuestro medio, como refleja un reciente estudio donde el 53% de los nuevos casos diagnosticados de hepatitis crónica B correspondían a personas inmigrantes 34 .…”

The State of Hepatitis B and C in the Mediterranean and Balkan Countries: Report from a Summit Conference

“…In Spain, cirrhosis accounted for 17 684-20 897 disability-adjusted life years (DALYs) lost due to HCV-related chronic hepatitis and 5021 DALYs lost due to chronic hepatitis B in 2006. Hepatocellular carcinoma (HCC) due to chronic hepatitis C and B was responsible for 12 005-14 004 DALYs and 2005 DALYs lost, respectively [23]. Croatia's national cancer registry reports a slowly increasing burden of HCC, although the incidence of HCV is declining [24].…”