HCV under-documented on death certificates

Mahajan R. Clin Infect Dis. 2014;doi:10.1093/cid/ciu077.

  • February 21, 2014

Only 19% of people dying with hepatitis C virus had the disease listed on their death certificates, according to CDC researchers.

“This indicates a significant underestimation of the number of deaths among people with HCV and the true medical and public health impact of HCV,” the researchers wrote in Clinical Infectious Diseases. “For purposes of public health, policy planning, disease modeling and medical care, this is a huge burden that should be reported and hopefully spur public health action as curative, all-oral therapies are becoming available to treat HCV.”

The researchers compared mortality data from patients in the Chronic Hepatitis Cohort Study (CHeCS) with Multiple Cause of Death (MCOD) data. At CHeCS sites from 2006 to 2010, 11,703 patients had diagnosed HCV infection, and of these, 1,590 (14%) died. There were 12 million death certificates used for the MCOD data. Among people in the CHeCS cohort, most were born from 1945 to 1965, and the mean age of death was 59 years, 15 years younger than MCOD deaths.

Among the CHeCS cohort, the age-adjusted mortality rate among those with HCV was 12,854 per 100,000 persons vs. the MCOD mortality rate of 1,046 per 100,000 persons. Despite having a confirmed HCV infection, only 19% (n=306) had HCV infection listed on the death certificate. Nearly half of the deaths (n=752) were liver-related.

When the researchers looked at ICD-9-CM codes before death for those in the CHeCS cohort, they found that 63% had chronic liver disease, 76% had moderate fibrosis (FIB-4 score >2) and 60% had cirrhosis (FIB-4 score >4).

“In this analysis, we have tried to be clear about the difference dying with HCV and dying from HCV, but both represent a substantial public health burden,” the researchers wrote. “Addressing the true impact of HCV, including of those chronically infected with HCV who are not utilizing health services, will be essential to appropriately respond to this epidemic.”

Disclosure: The CHeCS is funded by the CDC Foundation, which receives grants from AbbVie, Abbott, Genentech, Janssen, Johnson & Johnson and Vertex.