Abstract
Background Hepatitis C virus (HCV) infection incidence rates in the United States have increased since 2010 as a byproduct of the opioid crisis despite the introduction of direct-acting antiviral agents in 2013. HCV infection is associated with higher rates of liver-related and nonhepatic causes of death. Methods This study compared demographic characteristics and age-adjusted death rates from 1995 to 2016 among Alaska Native (AN) adults infected with HCV (AK-HepC) to rates among the AN and non-AN adult populations living in Alaska. Liver-related disease (LRD) and other disease-specific age-adjusted death rates were compared between the populations. Results The all-cause death rate among the AK-HepC cohort was 2.2- and 3.4-fold higher than AN and non-AN adults, respectively, and remained stable over time in all populations. The LRD death rate among the AK-HepC cohort was 18- and 11-fold higher than the non-AN and AN, respectively. The liver cancer rate among the AK-HepC cohort was 26-fold higher compared to the Alaska statewide population. The AK-HepC cohort had elevated rates of death associated with nonhepatic diseases with circulatory disease having the highest rate in all populations. Among liver cancer deaths in the AK-HepC cohort, 32% had HCV listed as a contributing cause of death on the death certificate. Conclusions Death rates in the AK-HepC cohort remained stable since 1995 and higher compared to the general population. People with HCV infection had an elevated risk for all-cause, liver-related, and nonhepatic causes of death. Hepatitis C infection may be underrepresented as a cause of mortality in the United States.
Highlights
Hepatitis C virus (HCV) infection is a blood-borne infection that continues to be a major cause of morbidity and mortality worldwide
Most people infected with HCV either are asymptomatic or have mild nonspecific symptoms, while others develop chronic infection and complications, including cirrhosis, liver failure, and hepatocellular carcinoma (HCC), potentially leading to premature death [2, 3]. e overall death rates among those infected with HCV increased during 1999 to 2013 in persons born between 1945 and 1965; an estimated 75% of infected persons are among this baby boomer generation [2, 4, 5]
Hepatitis C-related deaths are the result of direct effects of HCV infection on the liver; people with chronic HCV infection are at increased risk of death from other causes [1, 4, 7]. is includes deaths associated with chronic inflammation and inflammatory cytokine release induced by HCV infection which contribute to the development of diabetes, heart disease, and some cancers, as well as related factors that are connected to HCV exposure, such as intravenous drug use (IDU) and mental health disorders [4, 8, 9]
Summary
Hepatitis C virus (HCV) infection incidence rates in the United States have increased since 2010 as a byproduct of the opioid crisis despite the introduction of direct-acting antiviral agents in 2013. HCV infection is associated with higher rates of liver-related and nonhepatic causes of death. Is study compared demographic characteristics and age-adjusted death rates from 1995 to 2016 among Alaska Native (AN) adults infected with HCV (AK-HepC) to rates among the AN and non-AN adult populations living in Alaska. Liver-related disease (LRD) and other disease-specific age-adjusted death rates were compared between the populations. E all-cause death rate among the AK-HepC cohort was 2.2- and 3.4-fold higher than AN and non-AN adults, respectively, and remained stable over time in all populations. E LRD death rate among the AK-HepC cohort was 18- and 11-fold higher than the non-AN and AN, respectively. E liver cancer rate among the AK-HepC cohort was 26-fold higher compared to the Alaska statewide population. People with HCV infection had an elevated risk for allcause, liver-related, and nonhepatic causes of death. Hepatitis C infection may be underrepresented as a cause of mortality in the United States
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