Hospital-related morbidity in people notified with hepatitis C: A population-based record linkage study in New South Wales, Australia

Abstract

Statistics are available about hepatitis C (HCV)-related transplants, mortality and cancer risk but little is known about morbidity in the earlier stages of infection. We examined condition specific (principal diagnosis) and overall hospitalization rates for the cohort of individuals notified with hepatitis C in New South Wales (NSW), Australia. HCV notifications in NSW were linked to their hospital records (available for July 2000 to June 2006), HIV and hepatitis B notifications, and death records. Cases co-infected with HIV or hepatitis B were excluded. Hospitalization rates by person-years of observation were calculated and compared with those expected using rates for the NSW population to calculate standardized hospitalization ratios (SHRs). Patterns of admission were generally similar to the NSW population, with the highest rates in the elderly. However, rates were 42% higher than expected overall and significantly increased in ages 15-64 years. The greatest was excess in 15-19 year olds (SHR 3.8, 95% CI 3.4-4.2), especially females (SHR 4.5, 95% CI 4.1-4.9). Lifestyle factors accounted for the highest absolute and relative rates in young adults while liver disease contributed the greatest burden in older adults. Illicit drug-related conditions accounted for 9% of admissions (SHR 16.1, 95% CI 15.7-16.6) while alcohol and liver-related conditions each accounted for 5% (SHRs 5.1, 95% CI 4.9-5.4 and 15.7, 95% CI 15.0-16.4, respectively). Our findings highlight the need for strategies to minimize lifestyle-related harms, including alcohol consumption, and to improve HCV treatment uptake, in order to reduce morbidity in people with HCV infection.