Mortality in hepatitis C patients who achieve a sustained viral response compared to the general population
[Display omitted] 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. Individuals attaining SVR in Scotland in 1996–2011 wer...
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| creator | Innes, Hamish McDonald, Scott Hayes, Peter Dillon, John F Allen, Sam Goldberg, David Mills, Peter R Barclay, Stephen T Wilks, David Valerio, Heather Fox, Ray Bhattacharyya, Diptendu Kennedy, Nicholas Morris, Judith Fraser, Andrew Stanley, Adrian Bramley, Peter Hutchinson, Sharon J |
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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.
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.
We identified 1824 patients, followed on average for 5.2years 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% confidence interval (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)
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.
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 and injecting drug use were associated with a higher mortality risk. |
| doi_str_mv | 10.1016/j.jhep.2016.08.004 |
| format | Article |
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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.
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.
We identified 1824 patients, followed on average for 5.2years 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% confidence interval (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)
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.
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 and injecting drug use were associated with a higher mortality risk.</description><identifier>ISSN: 0168-8278</identifier><identifier>EISSN: 1600-0641</identifier><identifier>DOI: 10.1016/j.jhep.2016.08.004</identifier><identifier>PMID: 27545496</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Adult ; Aged ; Antiviral Agents - adverse effects ; Antiviral Agents - therapeutic use ; Cause of Death ; Cure ; Databases, Factual ; Death ; Epidemiology ; Excess mortality ; Female ; Gastroenterology and Hepatology ; Hepatitis ; Hepatitis C ; Hepatitis C, Chronic - drug therapy ; Hepatitis C, Chronic - mortality ; Hepatitis C, Chronic - virology ; Humans ; Liver cancer ; Liver Neoplasms - epidemiology ; Male ; Medical prognosis ; Middle Aged ; Mortality ; Patients ; Prognosis ; Regression analysis ; Risk Factors ; Scotland - epidemiology ; Sustained Virologic Response ; Viruses</subject><ispartof>Journal of hepatology, 2017-01, Vol.66 (1), p.19-27</ispartof><rights>European Association for the Study of the Liver</rights><rights>2016 European Association for the Study of the Liver</rights><rights>Copyright © 2016 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.</rights><rights>Copyright Elsevier Science Ltd. Jan 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c549t-ab51975c5442e7ceb4c80d5d2db83f563d3a11f4bdfdd986eb23a2c7248dd9b93</citedby><cites>FETCH-LOGICAL-c549t-ab51975c5442e7ceb4c80d5d2db83f563d3a11f4bdfdd986eb23a2c7248dd9b93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0168827816304287$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27545496$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Innes, Hamish</creatorcontrib><creatorcontrib>McDonald, Scott</creatorcontrib><creatorcontrib>Hayes, Peter</creatorcontrib><creatorcontrib>Dillon, John F</creatorcontrib><creatorcontrib>Allen, Sam</creatorcontrib><creatorcontrib>Goldberg, David</creatorcontrib><creatorcontrib>Mills, Peter R</creatorcontrib><creatorcontrib>Barclay, Stephen T</creatorcontrib><creatorcontrib>Wilks, David</creatorcontrib><creatorcontrib>Valerio, Heather</creatorcontrib><creatorcontrib>Fox, Ray</creatorcontrib><creatorcontrib>Bhattacharyya, Diptendu</creatorcontrib><creatorcontrib>Kennedy, Nicholas</creatorcontrib><creatorcontrib>Morris, Judith</creatorcontrib><creatorcontrib>Fraser, Andrew</creatorcontrib><creatorcontrib>Stanley, Adrian</creatorcontrib><creatorcontrib>Bramley, Peter</creatorcontrib><creatorcontrib>Hutchinson, Sharon J</creatorcontrib><title>Mortality in hepatitis C patients who achieve a sustained viral response compared to the general population</title><title>Journal of hepatology</title><addtitle>J Hepatol</addtitle><description>[Display omitted]
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.
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.
We identified 1824 patients, followed on average for 5.2years 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% confidence interval (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)
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.
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 and injecting drug use were associated with a higher mortality risk.</description><subject>Adult</subject><subject>Aged</subject><subject>Antiviral Agents - adverse effects</subject><subject>Antiviral Agents - therapeutic use</subject><subject>Cause of Death</subject><subject>Cure</subject><subject>Databases, Factual</subject><subject>Death</subject><subject>Epidemiology</subject><subject>Excess mortality</subject><subject>Female</subject><subject>Gastroenterology and Hepatology</subject><subject>Hepatitis</subject><subject>Hepatitis C</subject><subject>Hepatitis C, Chronic - drug therapy</subject><subject>Hepatitis C, Chronic - mortality</subject><subject>Hepatitis C, Chronic - virology</subject><subject>Humans</subject><subject>Liver cancer</subject><subject>Liver Neoplasms - epidemiology</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Patients</subject><subject>Prognosis</subject><subject>Regression analysis</subject><subject>Risk Factors</subject><subject>Scotland - epidemiology</subject><subject>Sustained Virologic Response</subject><subject>Viruses</subject><issn>0168-8278</issn><issn>1600-0641</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9ksFu1DAQhi0EotvCC3BAlrhwSbAdx3EkhFStoFQq6qFwthx7wjrNxsF2ttq3x9GWHnrg5Bn7m1_j-Qehd5SUlFDxaSiHHcwly3FJZEkIf4E2VBBSEMHpS7TJD7KQrJFn6DzGgRBSkZa_RmesqXnNW7FB9z98SHp06YjdhLOcTi65iLd4jWBKET_sPNZm5-AAWOO4xKTdBBYfXNAjDhBnP0XAxu9nHfJ98jjtAP-GCVZg9vMyZi0_vUGvej1GePt4XqBf377-3H4vbm6vrreXN4XJPaVCdzVtmzonnEFjoONGEltbZjtZ9bWobKUp7Xlne2tbKaBjlWamYVzmvGurC_TxpDsH_2eBmNTeRQPjqCfwS1RU1kzUQtQyox-eoYNfwpS7U4xI0rYst5QpdqJM8DEG6NUc3F6Ho6JErVaoQa1WqNUKRaTKVuSi94_SS7cH-1Tyb_YZ-HwCIM_i4CCoaPLEDVgXwCRlvfu__pdn5WZ0kzN6vIcjxKd_UBWZIupuXYZ1F6ioCGeyqf4CVnCwhQ</recordid><startdate>20170101</startdate><enddate>20170101</enddate><creator>Innes, Hamish</creator><creator>McDonald, Scott</creator><creator>Hayes, Peter</creator><creator>Dillon, John F</creator><creator>Allen, Sam</creator><creator>Goldberg, David</creator><creator>Mills, Peter R</creator><creator>Barclay, Stephen T</creator><creator>Wilks, David</creator><creator>Valerio, Heather</creator><creator>Fox, Ray</creator><creator>Bhattacharyya, Diptendu</creator><creator>Kennedy, Nicholas</creator><creator>Morris, Judith</creator><creator>Fraser, Andrew</creator><creator>Stanley, Adrian</creator><creator>Bramley, Peter</creator><creator>Hutchinson, Sharon J</creator><general>Elsevier B.V</general><general>Elsevier Science Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>7X8</scope></search><sort><creationdate>20170101</creationdate><title>Mortality in hepatitis C patients who achieve a sustained viral response compared to the general population</title><author>Innes, Hamish ; 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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.
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.
We identified 1824 patients, followed on average for 5.2years 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% confidence interval (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)
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.
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 and injecting drug use were associated with a higher mortality risk.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>27545496</pmid><doi>10.1016/j.jhep.2016.08.004</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of hepatology, 2017-01, Vol.66 (1), p.19-27 |
| issn | 0168-8278 1600-0641 |
| language | eng |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Adult Aged Antiviral Agents - adverse effects Antiviral Agents - therapeutic use Cause of Death Cure Databases, Factual Death Epidemiology Excess mortality Female Gastroenterology and Hepatology Hepatitis Hepatitis C Hepatitis C, Chronic - drug therapy Hepatitis C, Chronic - mortality Hepatitis C, Chronic - virology Humans Liver cancer Liver Neoplasms - epidemiology Male Medical prognosis Middle Aged Mortality Patients Prognosis Regression analysis Risk Factors Scotland - epidemiology Sustained Virologic Response Viruses |
| title | Mortality in hepatitis C patients who achieve a sustained viral response compared to the general population |
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