The Impact of Infection on Population Health: Results of the Ontario Burden of Infectious Diseases Study

Kwong, Jeffrey C.; Ratnasingham, Sujitha; Campitelli, Michael A.; Daneman, Nick; Deeks, Shelley L.; Dujovny, Manuel; Allen, Vanessa; Bayoumi, Ahmed M.; Fazil, Aamir; Fisman, David N.; Gershon, Andrea S.; Gournis, Effie; Heathcote, E. Jenny; Jamieson, Frances; Jha, Prabhat; Khan, Kamran; Majowicz, Shannon E.; Mazzulli, Tony; McGeer, Allison; Muller, Matthew P.; Raut, Abhishek; Rea, Elizabeth; Remis, Robert S.; Shahin, Rita; Wright, Alissa; Zagorski, Brandon; Crowcroft, Natasha S.

doi:10.1371/journal.pone.0044103

Cited by 114 publications

(83 citation statements)

References 21 publications

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“…[6][7][8] Based on health-adjusted lifeyears, a composite measure of premature mortality and reduced functioning because of disease, hepatitis C accounts for the largest proportion of disease burden among 51 infectious diseases in Ontario. 9 A study in British Columbia found significantly elevated standardized mortality ratios for liver-and drugrelated causes of death as well as for all-cause mortality among…”

Section: Researchmentioning

confidence: 99%

Historical trends and projected hospital admissions for chronic hepatitis C infection in Canada: a birth cohort analysis

2014

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Background:Much of the recent increase in hospital admission rates and mortality associated with hepatitis C in Canada is believed to be because of a higher prevalence of hepatitis C virus infection among those born between 1945 and 1965 (the baby boomer generation). We explored the effects of birth cohort on the rates of and projected trends in hospital admissions associated with hepatitis C. Methods:The hospital records of 17 344 inpatients with a diagnosis of chronic hepatitis C and liver disease, including liver cancer, were extracted from the Canadian Discharge Abstract Database for April 2004 to March 2011. For each 5-year birth cohort from 1915 to 1984, regression analysis was used to estimate the temporal trends associated with the average age of the cohort during the study period. Future hospital admissions were predicted based on the assumption that past trends would continue.Results: Hospital admissions associated with hepatitis C and liver disease increased an average of 6.0% (95% confidence interval [CI] 4.4%-7.7%) a year over the study period. As of 2010, hospital admission rates were highest for the 1950-1954 and 1955-1959 birth cohorts, at 17.6 (95% CI 13.2-23.5) and 13.7 (95% CI 10.3-18.2) times the rate for the 1970-1974 birth cohort. The corresponding same-age rate ratios predicted under a status quo scenario were 3.6 (95% CI 2.3-4.9) and 3.4 (95% CI 2.1-4.7). Same-age rate ratios were significantly higher for the four 5-year birth cohorts between 1950 and 1969 compared with other birth cohorts.Interpretation: Hospital admissions associated with chronic hepatitis C and liver disease were significantly higher for the 1950-1954 and 1955-1959 birth cohorts than for most other birth cohorts. Without further interventions, the disease burden associated with hepatitis C will continue to increase for most birth cohorts, likely peaking after age 70 years. The substantial disease burden emerging in younger birth cohorts should be monitored Abstract E140CMAJ OPEN, 2(3) ResearchCMAJ OPEN people who had tested positive for HCV compared with those who had tested negative.

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Section: Researchmentioning

confidence: 99%

Historical trends and projected hospital admissions for chronic hepatitis C infection in Canada: a birth cohort analysis

2014

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“…1 It is the leading indication for liver transplantation, and HCV-related morbidity and mortality is projected to rise until 2027, with staggering economic costs. 2 Infected individuals often remain entirely asymptomatic until liver damage is advanced; they typically present only when symptoms from decompensated cirrhosis or liver cancer develop.…”

Section: H Epatitis C Virus (Hcv) Infectionmentioning

confidence: 99%

A Canadian screening program for hepatitis C: Is now the time?

Shah

Heathcote

Feld

2013

CMAJ

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Analysis CMAJ• Hepatitis C virus (HCV) infection has an enormous impact on population health in Canada and is likely underdiagnosed.• A national strategy to screen for and treat HCV infections would substantially reduce HCV-related morbidity and mortality.• Birth-cohort screening of people born between 1945 and 1975 coupled with a strategy for follow-up treatment and education is probably the best method to identify and provide care to affected people in Canada.• Population-level data on the prevalence and health impact of HCV infection are needed in Canada. Key points © 2013 Canadian Medical Association or its licensorsCMAJ, October 15, 2013, 185(15) 1325 markedly lower than in countries with active surveillance programs for HCV, and, if correct, would place Canada among the top countries in the world at diagnosing HCV infections despite not having a national screening program. The CDC estimates that 63% of Americans with HCV are unaware of their infection, 7 and underdiagnosis is highly prevalent even among people with insurance and access to care.11 Data from Europe show a similar pattern. Before introducing an intensive national program, 75% of infected individuals in France were unaware of their infection; after introduction of this program, the rate decreased to 44%. 12 Given that it took a major national effort in France to get the diagnosis rate to 56%, it seems unlikely that Canada's estimate that 79% of infected individuals are aware of their diagnosis is correct.The Canadian data may be inaccurate for 2 major reasons. First, diagnosed cases may have been inadvertently counted more than once. Second, and more importantly, the overall prevalence may be considerably higher than estimated, particularly because groups at high risk of HCV infection are often undersampled. With the same number of positive test results, a higher prevalence would lead to a lower diagnosis rate. If Canadian data are similar to those in countries with comparable health care systems (e.g., France), the rate of underdiagnosis is likely much higher than 21%, and strategies to decrease this rate are needed. What are the benefits and risks of screening?Hepatitis C virus meets the criteria for a condition for which screening specific populations is potentially useful. There are many benefits: HCV is a major cause of morbidity and mortality; the prevalence of HCV is increased among baby boomers; many individuals are unaware that they are infected; and HCV infection is curable, with early intervention leading to improved overall health outcomes. Patients whose infection has been eradicated before cirrhosis develops have a life expectancy similar to that of uninfected people.13 If cirrhosis develops before treatment, viral eradication eliminates the risk of liver failure and markedly reduces the risk of hepatocellular cancer. 3,13 There are potential risks associated with screening, including individuals feeling stigmatized by being "targeted," false positive results and a lack of capacity to treat the volume of newly diagnosed cases. ...

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“…Nonetheless, many gaps remain in our understanding of the disease, and the burden it imposes on the health of Americans and others continues unabated. A recent Canadian study revealed that HCV was first among 51 infectious agents in causing loss of healthadjusted life years, and accounted for 11% of the overall health burden caused by infectious diseases in Ontario (2). Since 2007, the annual number of deaths attributable to hepatitis C within the United States has exceeded those caused by HIV/ AIDS (3), and projections are that the number of HCV-infected individuals with cirrhosis or hepatocellular carcinoma, the final stages of HCV-associated liver disease, will continue to increase significantly over the next decade (4).…”

mentioning

confidence: 99%