Mortality associated with hepatitis C and hepatitis B virus infection: A nationwide study on multiple causes of death data

Abstract

AIMTo analyze mortality associated with hepatitis C virus (HCV) and hepatitis B virus (HBV) infection in Italy.METHODSDeath certificates mentioning either HBV or HCV infection were retrieved from the Italian National Cause of Death Register for the years 2011-2013. Mortality rates and proportional mortality (percentage of deaths with mention of HCV/HBV among all registered deaths) were computed by gender and age class. The geographical variability in HCV-related mortality rates was investigated by directly age-standardized rates (European standard population). Proportional mortality for HCV and HBV among subjects aged 20-59 years was assessed in the native population and in different immigrant groups.RESULTSHCV infection was mentioned in 1.6% (n = 27730) and HBV infection in 0.2% (n = 3838) of all deaths among subjects aged ≥ 20 years. Mortality rates associated with HCV infection increased exponentially with age in both genders, with a male to female ratio close to unity among the elderly; a further peak was observed in the 50-54 year age group especially among male subjects. HCV-related mortality rates were higher in Southern Italy among elderly people (45/100000 in subjects aged 60-79 and 125/100000 in subjects aged ≥ 80 years), and in North-Western Italy among middle-aged subjects (9/100000 in the 40-59 year age group). Proportional mortality was higher among Italian citizens and North African immigrants for HCV, and among Sub-Saharan African and Asian immigrants for HBV.CONCLUSIONPopulation ageing, immigration, and new therapeutic approaches are shaping the epidemiology of virus-related chronic liver disease. In spite of limits due to the incomplete reporting and misclassification of the etiology of liver disease, mortality data represent an additional source of information for surveillance.

Prevalence of chronic liver disease among young/middle-aged adults in Northern Italy: role of hepatitis B and hepatitis C virus infection by age, sex, ethnicity

“…These findings suggest the occurrence of two epidemic waves of HCV infection in Italy: the first in the 1950s, due to unsafe medical procedures, and the second one in young people in the late 1970s and in the 1980s, due to the diffusion of intravenous drug use [3]. Such second epidemic wave was confirmed by analyses of Italian death certificates, with an exponential increase of HCV-related mortality with age, and a further peak observed in the 50-54-year age-group especially among males [21]. This second wave can also explain the increase in HCV-related mortality observed from 2008-2012 to 2013–2016 among middle-aged males in the Veneto Region [6].…”

Increasing mortality associated with the more recent epidemic wave of hepatitis C virus infection in Northern Italy

“…Within this context, Italy has been affected by at least two distinct major epidemic waves: the first wave, associated with unsafe healthcare procedures, occurred in the 1950s and 1960s; the second wave affected young adults in the late 1970s and 1980s along with the diffusion of intravenous drug use . Such a complex epidemiological scenario is reflected by seroprevalence surveys demonstrating a bimodal distribution of HCV infection, with higher rates in the elderly and a minor peak in younger subjects, and by analyses of death certificates: in 2011‐2013, mortality rates associated with HCV infection increased exponentially with age in both genders, with a further peak observed in the 50‐ to 54‐year age‐group especially among males . Due to the vanishing effect of the oldest epidemic, HCV infection in Italy might be considered as a feature mostly of elderly subjects, with a declining burden of associated chronic liver disease …”

“…3 Such a complex epidemiological scenario is reflected by seroprevalence surveys demonstrating a bimodal distribution of HCV infection, with higher rates in the elderly and a minor peak in younger subjects, 4 and by analyses of death certificates: in 2011-2013, mortality rates associated with HCV infection increased exponentially with age in both genders, with a further peak observed in the 50-to 54-year age-group especially among males. 5 of HCV infection demonstrated an annual percentage increase in mortality rates by 3.4%. 6 HCV-related mortality steeply increases as the affected US birth cohort ages, and a similar trend may be predicted to occur also in Italy.…”

Update on Hepatitis C Epidemiology: Unaware and Untreated Infected Population Could Be the Key to Elimination

“…According to Eurostat data, Italy ranks in first place for the highest mortality rate due to viral hepatitis among the EU Member States, with 40 deaths from viral hepatitis per million inhabitants [ 7 ]. In an Italian study [ 8 ], conducted by analysing data from the National Registry of Causes of Death, on all deaths of individuals aged ≥ 20 years, HCV infection was found in 1.6% (corresponding to 27,730 deaths). The mortality rate associated with HCV infection increases exponentially with age in both sexes and it is higher in southern Italy, with the highest peak among elderly people aged 60 or older.…”