The contribution of health risk behaviors to excess mortality in American adults with chronic hepatitis C: A population cohort‐study

Abstract

In resource-rich countries, chronic hepatitis C (CHC) infection is associated with a sizeable excess mortality risk. The extent to which this is due to (1) the biological sequelae of CHC infection versus (2) a high concomitant burden of health risk behaviors (HRBs) is unclear. We used data from the 1999-2010 U.S. National Health and Nutritional Examination Surveys (NHANES), which include detailed information on HRBs and CHC infection status. We calculated the prevalence of the five major HRBs-alcohol use; cigarette smoking, physical inactivity, unhealthy diet, and illicit drug useaccording to CHC after adjusting for sociodemographic differences. Mortality status after survey interview was ascertained by linkage to the U.S. National Death Index. To assess the contribution of HRBs to the excess mortality risk, we determined the all-cause mortality rate ratio (MRR) for individuals with CHC relative to individuals without, and then calculated the attenuation in this MRR following adjustment for HRBs. This analysis included 27,468 adult participants of NHANES of which 363 tested positive for CHC. All HRBs were markedly more prevalent among individuals with CHC versus individuals without. CHC was associated with a 2.4-fold higher mortality rate after adjustment for sociodemographic factors (MRR, 2.36; 95% CI, 1.60-3.49). Subsequent adjustment for all five HRBs attenuated this ratio by 50.7% to MRR 1.67 (95% CI, 1.14-2.44). Higher levels of attenuation (69.1%) were observed among individuals aged 45-70 years, who form the target demographic for U.S. birth cohort screening. Conclusion: At least half the excess mortality risk for individuals with CHC in the United States may be attributed to HRBs rather than CHC. The remedial response to hepatitis C must not neglect action on HRBs if it is to fully resolve the high mortality problem in this population. (HEPA-TOLOGY 2018;67:97-107).

Population impact of direct-acting antiviral treatment on new presentations of hepatitis C-related decompensated cirrhosis: a national record-linkage study

“…The above differential finding—vis-à-vis a 51% reduction among those with chronic HCV either currently or in the past vs 67% reduction among those with chronic HCV currently—was anticipated. Previous work has shown that heavy alcohol use, as well as other health risk behaviours known to accelerate liver disease progression, are prevalent in HCV-infected populations both in Scotland and elsewhere, and may compromise the clinical benefit of DAAs 20 24 30. New DC presentations among those who had cleared HCV from therapy almost doubled from 15 in 2014 to 27 in 2018; 64% of the latter had an alcohol-related admission history.…”

Patterns of Drug and Alcohol Use and Injection Equipment Sharing Among People With Recent Injecting Drug Use or Receiving Opioid Agonist Treatment During and Following Hepatitis C Virus Treatment With Direct-acting Antiviral Therapies: An International Study

“…While most participants reported low or moderate levels of alcohol use, approximately 16% reported heavy use, according to AUDIT-C criteria [22], and this pattern remained consistent throughout follow-up. Among people with chronic hepatitis C, heavy alcohol use has been linked to excess mortality [32].…”

Burden of Co-Infection: A Cost Analysis of Human Immunodeficiency Virus in a Commercially Insured Hepatitis C Virus Population

“…Substance abuse disorders have frequently been cited as potential drivers of morbidity and mortality for patients with HIV and/or HCV infection [ 26 , 27 ]. Opioid abuse in high-income countries like the US, in particular, has been associated with a higher disease burden related to HIV and HCV [ 26 ].…”