Mortality among patients with cleared hepatitis C virus infection compared to the general population: a Danish nationwide cohort study

Lars Haukali Omland; Peer Brehm Christensen; Henrik Bygum Krarup; Peter Jepsen; Nina Weis; Henrik Toft Sørensen; Niels Obel; DANVIR Cohort Study; Jette Marie Bangsborg

doi:10.1371/journal.pone.0022476

Mortality among patients with cleared hepatitis C virus infection compared to the general population: a Danish nationwide cohort study

Lars Haukali Omland, Peer Brehm Christensen, Henrik Bygum Krarup, Peter Jepsen, Nina Weis, Henrik Toft Sørensen, Niels Obel, DANVIR Cohort Study, Jette Marie Bangsborg

11 Citationer (Scopus)

Abstract

Background: The increased mortality in HCV-infected individuals partly stems from viral damage to the liver and partly from risk-taking behaviours. We examined mortality in patients who cleared their HCV-infection, comparing it to that of the general population. We also addressed the question whether prognosis differed according to age, substance abuse (alcohol abuse and injection drug use) and comorbidity. Methodology/Principal Findings: Patients with cleared HCV-infection were categorized into one of 8 groups according to age (20-39 years or 40-69 years) and patient characteristics (no substance abuse/no comorbidity; substance abuse/no comorbidity; no substance abuse/comorbidity; and substance abuse/comorbidity). For each patient, 4 age- and gender-matched individuals without substance abuse or comorbidity were selected from the general population, comprising a total of 8 comparison cohorts. We analyzed 10-year survival and used stratified Cox Regression analysis to compute mortality rate ratios (MRRs), comparing mortality between the 8 patient groups and the comparison cohorts, adjusting for personal income. Among patients without substance abuse or comorbidity, those aged 40-69 years had the same mortality as the comparison cohort (10-year survival: 95% (95% confidence interval [CI]: 93%-97%), MRR: 1.3 (95% CI: 0.8-2.3)), whereas those aged 20-39 years had higher mortality than the comparison cohort (10-year survival: 93% versus 99%, MRR: 5.7 (95% CI: 2.3-14.0). For both age categories, substance abuse and comorbidity decreased survival and increased MRRs. Patients aged 40-69 years with substance abuse and comorbidity suffered from substantial mortality (MRR: 12.5 (95% CI: 5.1-30.6)). Conclusions: Mortality in patients aged 40-69 years with cleared HCV-infection is comparable to individuals without HCV, provided they have no substance abuse or comorbidity. Any substance abuse and/or comorbidity not captured in the registries used for our study could explain the increased mortality in patients aged 20-39 years without documented substance abuse or comorbidity.

Originalsprog	Engelsk
Tidsskrift	P L o S One
Vol/bind	6
Udgave nummer	7
Sider (fra-til)	e22476
ISSN	1932-6203
DOI	https://doi.org/10.1371/journal.pone.0022476
Status	Udgivet - 2011

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10.1371/journal.pone.0022476

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title = "Mortality among patients with cleared hepatitis C virus infection compared to the general population: a Danish nationwide cohort study",

abstract = "Background: The increased mortality in HCV-infected individuals partly stems from viral damage to the liver and partly from risk-taking behaviours. We examined mortality in patients who cleared their HCV-infection, comparing it to that of the general population. We also addressed the question whether prognosis differed according to age, substance abuse (alcohol abuse and injection drug use) and comorbidity. Methodology/Principal Findings: Patients with cleared HCV-infection were categorized into one of 8 groups according to age (20-39 years or 40-69 years) and patient characteristics (no substance abuse/no comorbidity; substance abuse/no comorbidity; no substance abuse/comorbidity; and substance abuse/comorbidity). For each patient, 4 age- and gender-matched individuals without substance abuse or comorbidity were selected from the general population, comprising a total of 8 comparison cohorts. We analyzed 10-year survival and used stratified Cox Regression analysis to compute mortality rate ratios (MRRs), comparing mortality between the 8 patient groups and the comparison cohorts, adjusting for personal income. Among patients without substance abuse or comorbidity, those aged 40-69 years had the same mortality as the comparison cohort (10-year survival: 95% (95% confidence interval [CI]: 93%-97%), MRR: 1.3 (95% CI: 0.8-2.3)), whereas those aged 20-39 years had higher mortality than the comparison cohort (10-year survival: 93% versus 99%, MRR: 5.7 (95% CI: 2.3-14.0). For both age categories, substance abuse and comorbidity decreased survival and increased MRRs. Patients aged 40-69 years with substance abuse and comorbidity suffered from substantial mortality (MRR: 12.5 (95% CI: 5.1-30.6)). Conclusions: Mortality in patients aged 40-69 years with cleared HCV-infection is comparable to individuals without HCV, provided they have no substance abuse or comorbidity. Any substance abuse and/or comorbidity not captured in the registries used for our study could explain the increased mortality in patients aged 20-39 years without documented substance abuse or comorbidity.",

keywords = "Adult, Alcoholism, Cause of Death, Cohort Studies, Comorbidity, Denmark, Female, Hepacivirus, Hepatitis C, Humans, Incidence, Kaplan-Meier Estimate, Male, Middle Aged, Substance Abuse, Intravenous",

author = "Omland, {Lars Haukali} and Christensen, {Peer Brehm} and Krarup, {Henrik Bygum} and Peter Jepsen and Nina Weis and S{\o}rensen, {Henrik Toft} and Niels Obel and {DANVIR Cohort Study} and Bangsborg, {Jette Marie}",

year = "2011",

doi = "10.1371/journal.pone.0022476",

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journal = "PLoS Computational Biology",

issn = "1932-6203",

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TY - JOUR

T1 - Mortality among patients with cleared hepatitis C virus infection compared to the general population

T2 - a Danish nationwide cohort study

AU - Omland, Lars Haukali

AU - Christensen, Peer Brehm

AU - Krarup, Henrik Bygum

AU - Jepsen, Peter

AU - Weis, Nina

AU - Sørensen, Henrik Toft

AU - Obel, Niels

AU - DANVIR Cohort Study

AU - Bangsborg, Jette Marie

PY - 2011

Y1 - 2011

N2 - Background: The increased mortality in HCV-infected individuals partly stems from viral damage to the liver and partly from risk-taking behaviours. We examined mortality in patients who cleared their HCV-infection, comparing it to that of the general population. We also addressed the question whether prognosis differed according to age, substance abuse (alcohol abuse and injection drug use) and comorbidity. Methodology/Principal Findings: Patients with cleared HCV-infection were categorized into one of 8 groups according to age (20-39 years or 40-69 years) and patient characteristics (no substance abuse/no comorbidity; substance abuse/no comorbidity; no substance abuse/comorbidity; and substance abuse/comorbidity). For each patient, 4 age- and gender-matched individuals without substance abuse or comorbidity were selected from the general population, comprising a total of 8 comparison cohorts. We analyzed 10-year survival and used stratified Cox Regression analysis to compute mortality rate ratios (MRRs), comparing mortality between the 8 patient groups and the comparison cohorts, adjusting for personal income. Among patients without substance abuse or comorbidity, those aged 40-69 years had the same mortality as the comparison cohort (10-year survival: 95% (95% confidence interval [CI]: 93%-97%), MRR: 1.3 (95% CI: 0.8-2.3)), whereas those aged 20-39 years had higher mortality than the comparison cohort (10-year survival: 93% versus 99%, MRR: 5.7 (95% CI: 2.3-14.0). For both age categories, substance abuse and comorbidity decreased survival and increased MRRs. Patients aged 40-69 years with substance abuse and comorbidity suffered from substantial mortality (MRR: 12.5 (95% CI: 5.1-30.6)). Conclusions: Mortality in patients aged 40-69 years with cleared HCV-infection is comparable to individuals without HCV, provided they have no substance abuse or comorbidity. Any substance abuse and/or comorbidity not captured in the registries used for our study could explain the increased mortality in patients aged 20-39 years without documented substance abuse or comorbidity.

AB - Background: The increased mortality in HCV-infected individuals partly stems from viral damage to the liver and partly from risk-taking behaviours. We examined mortality in patients who cleared their HCV-infection, comparing it to that of the general population. We also addressed the question whether prognosis differed according to age, substance abuse (alcohol abuse and injection drug use) and comorbidity. Methodology/Principal Findings: Patients with cleared HCV-infection were categorized into one of 8 groups according to age (20-39 years or 40-69 years) and patient characteristics (no substance abuse/no comorbidity; substance abuse/no comorbidity; no substance abuse/comorbidity; and substance abuse/comorbidity). For each patient, 4 age- and gender-matched individuals without substance abuse or comorbidity were selected from the general population, comprising a total of 8 comparison cohorts. We analyzed 10-year survival and used stratified Cox Regression analysis to compute mortality rate ratios (MRRs), comparing mortality between the 8 patient groups and the comparison cohorts, adjusting for personal income. Among patients without substance abuse or comorbidity, those aged 40-69 years had the same mortality as the comparison cohort (10-year survival: 95% (95% confidence interval [CI]: 93%-97%), MRR: 1.3 (95% CI: 0.8-2.3)), whereas those aged 20-39 years had higher mortality than the comparison cohort (10-year survival: 93% versus 99%, MRR: 5.7 (95% CI: 2.3-14.0). For both age categories, substance abuse and comorbidity decreased survival and increased MRRs. Patients aged 40-69 years with substance abuse and comorbidity suffered from substantial mortality (MRR: 12.5 (95% CI: 5.1-30.6)). Conclusions: Mortality in patients aged 40-69 years with cleared HCV-infection is comparable to individuals without HCV, provided they have no substance abuse or comorbidity. Any substance abuse and/or comorbidity not captured in the registries used for our study could explain the increased mortality in patients aged 20-39 years without documented substance abuse or comorbidity.

KW - Adult

KW - Alcoholism

KW - Cause of Death

KW - Cohort Studies

KW - Comorbidity

KW - Denmark

KW - Female

KW - Hepacivirus

KW - Hepatitis C

KW - Humans

KW - Incidence

KW - Kaplan-Meier Estimate

KW - Male

KW - Middle Aged

KW - Substance Abuse, Intravenous

U2 - 10.1371/journal.pone.0022476

DO - 10.1371/journal.pone.0022476

M3 - Journal article

C2 - 21789259

SN - 1932-6203

VL - 6

SP - e22476

JO - PLoS Computational Biology

JF - PLoS Computational Biology

IS - 7

ER -

Mortality among patients with cleared hepatitis C virus infection compared to the general population: a Danish nationwide cohort study

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