In the Journals Plus

Patients with chronic HBV die at younger age

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August 6, 2018

Patients with chronic hepatitis B virus infection died an average of 14 years younger and had higher incidences of death from all causes compared with the general U.S. population, according to study results recently published in Clinical Infectious Diseases.

“In the United States, about 1,800 death certificates annually list hepatitis B virus (HBV) as an underlying or contributing cause of death,” researchers wrote. “However, accurately quantifying mortality related to hepatitis is difficult because of the prolonged period between infection and death and because death is not always linked to underlying infection. ... Underestimating the true prognosis of [chronic hepatitis B (CHB)] infection may have real consequences for patients.”

The researchers analyzed data from the Chronic Hepatitis Cohort Study (CHeCS) of patients with CHB seen between 2006 and 2013. The cohort was based on electronic health records of adults who received services at one of four large U.S. health systems in Pennsylvania, Michigan, Oregon and Hawaii. CHeCS CHB decedents and U.S. decedents from multiple causes of death were compared for overall and cause-specific death rates and mean age at death.

The researchers followed 4,389 patients with CHB for a mean of 5.38 years through Dec. 31, 2014, including 492 patients (11%) who died after a mean follow-up of 3 years. The decedents in the study were older and more likely to be white or black when compared with the survivor cohort. The survivors had twice the prevalence of being Asian (48.8% vs. 18.4%). Cirrhosis was much more prevalent in decedents (59.8%) compared with survivors (12%; P < .0001).

The decedents also were more likely than survivors to have evidence of diabetes (27.2%), a history of alcohol abuse (17.7%), hepatitis C or HIV coinfection, hepatocellular carcinoma (17.5%) or liver transplant (5.7%; P <.001, all).

Death certificates listing multiple causes of death were available for 409 (83%) of decedents with CHB. The researchers reported that patients with CHB died at an average age of 59.8 years, which was 14 years younger than the average age of death for the general U.S. population of 73.9 years (P < .0001). The patients with CHB also had higher rates for all causes (RR = 1.854; 95% CI, 1.851-1.857) and liver-related causes of death (RR = 15.91; 95% CI, 15.81-16.01). HBV was reported on the death certificates of 19% of CHB decedents and 40% of patients who died of liver disease.

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“Although the relative contribution of HBV to any individual death cannot always be determined with CHeCS data, our study suggests a meaningful effect of CHB on mortality for people living with this chronic condition,” the researchers wrote.

They concluded that the findings “strongly support hepatitis B elimination as a national public health goal. Clinicians can contribute to elimination of hepatitis B by vaccinating all unvaccinated high-risk adults for HBV; appropriate screening of all high-risk adults for HBV; and assuring that persons with HBV receive post-test counseling and clinical care.” – by Bruce Thiel

Disclosure: Bixler reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.