Trends in all cause and viral liver disease-related hospitalizations in people with hepatitis B or C: a population-based linkage study

Abstract

BackgroundPrevious studies have reported an excess burden of cancer and mortality in populations with chronic hepatitis B (HBV) or C (HCV), but there are limited data comparing hospitalization rates. In this study, we compared hospitalization rates for all causes and viral liver disease in people notified with HBV or HCV in New South Wales (NSW), Australia.MethodsHBV and HCV notifications were linked to their hospital (July 2000-June 2006), HIV and death records. Standardized hospitalization ratios (SHRs) were calculated using rates for the NSW population. Random effects Poisson regression was used to examine temporal trends.ResultsThe SHR for all causes and non alcoholic liver disease was two-fold higher in the HCV cohort compared with the HBV cohort (SHRs 1.4 (95%CI: 1.4-1.4) v 0.6 (95%CI: 0.6-0.6) and 14.0 (95%CI: 12.7-15.4) v 5.4 (95%CI: 4.5-6.4), respectively), whilst the opposite was seen for primary liver cancer (SHRs 16.2 (95%CI: 13.8-19.1) v 29.1 (95%CI: 24.7-34.2)). HIV co-infection doubled the SHR except for primary liver cancer in the HCV/HIV cohort. In HBV and HCV mono-infected cohorts, all cause hospitalization rates declined and primary liver cancer rates increased, whilst rates for non alcoholic liver disease increased by 9% in the HCV cohort but decreased by 14% in the HBV cohort (P < 0.001).ConclusionHospital-related morbidity overall and for non alcoholic liver disease was considerably higher for HCV than HBV. Improved treatment of advanced HBV-related liver disease may explain why HBV liver-related morbidity declined. In contrast, HCV liver-related morbidity increased and improved treatments, especially for advanced liver disease, and higher levels of treatment uptake are required to reverse this trend.

Trends in mortality after diagnosis of hepatitis B or C infection: 1992–2006

“…The contrasting trends in non-HCC liver-related mortality in our study are consistent with findings from a recent linkage study examining hospitalisations in New South Wales [40], which found a significant decrease in hospitalisation rates for non-alcoholic liver disease between 2000 and 2006 for both HBV and HCV infected people. The more striking trends in hospitalisation data are potentially explained by the relatively recent advances in antiviral treatment and uptake having impacted hospitalisation rates more immediately than mortality rates.…”

Chronic hepatitis C burden and care cascade in Australia in the era of interferon‐based treatment

“…The current study indicated that the number of individuals with HCV‐related advanced liver disease and requiring liver transplantation has increased markedly during the last decade. These findings are in line with other Australian data demonstrating the increased liver‐related hospitalization and mortality among individuals with HCV infection . This rising burden of HCV‐related liver disease relates to the “ageing cohort” effect in the HCV infected population, low HCV treatment uptake, and sub‐optimal efficacy of interferon‐based treatments, particularly in advanced liver disease.…”

Strategies to manage hepatitis C virus (HCV) disease burden

“…Liver disease already accounts for the greatest burden in hospital admissions among older HCV mono‐infected adults in New South Wales . In addition, hospital admissions for HCV‐related liver morbidity have recently increased . A marked increase in HCV treatment uptake will be required to reduce the incidence of advanced liver disease complications and deaths.…”