Authors: Duberg, Ann-Sofi¹; Törner, Anna²; Daviðsdóttir, Lóa³; Aleman, Soo³; Blaxhult, Anders²; Svensson, Åke⁴; Hultcrantz, Rolf³; Bäck, Erik⁵; Ekdahl, Karl⁶

Source: Journal of Viral Hepatitis, Volume 15, Number 7, July 2008 , pp. 538-550(13)

Publisher: Wiley-Blackwell

Abstract:

Summary. 

Studies on chronic viral hepatitis and mortality have often been made on selected populations or in high-endemic countries. The aim of this study was to investigate the causes of death and the mortality rates in the nationwide cohorts of people chronically infected with hepatitis B virus (HBV) and/or hepatitis C virus (HCV) in Sweden, a low-endemic country. All notifications on chronic HBV infection and HCV infection 1990-2003 were linked to the Cause of Death Register. A total of 9517 people with chronic HBV infection, 34 235 people with HCV infection and 1601 with chronic HBV-HCV co-infection were included, and the mean observation times were 6.4, 6.3 and 7.9 years, respectively. The mortality in the cohorts was compared with age- and gender-specific mortality in the general population and standardized mortality ratios (SMR) were calculated. All-cause mortality was significantly increased, SMR 2.3 (HBV), 5.8 (HCV) and 8.5 (HBV-HCV), with a great excess liver-related mortality in all cohorts, SMR 21.7, 35.5 and 46.2, respectively. In HCV and HBV-HCV infected there was an increased mortality due to drug-related psychiatric diagnoses (SMR: 20.7 and 27.6) and external causes (SMR: 12.4 and 11.4), predominantly at younger age. To conclude, this study demonstrated an increased all-cause mortality, with a great excess mortality from liver disease, in all cohorts. In people with HCV infection the highest excess mortality in younger ages was from drug-related and external reasons.

Keywords: chronic hepatitis; cohort study; epidemiology; mortality; natural history; Sweden

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1365-2893.2008.00982.x

Affiliations: 1: Department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden 2: Department of Epidemiology, Swedish Institute for Infectious Disease Control, Solna, Sweden 3: Department of Gastroenterology and Hepatology, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden 4: Division of Mathematical Statistics, Stockholm University, Stockholm, Sweden 5: Department of Clinical Medicine, Örebro University, Örebro, Sweden 6: Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden

Publication date: 2008-07-01

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