All-Cause, Liver-Related, and Non-Liver-Related Mortality Among HCV-Infected Individuals in the General US Population
All-Cause, Liver-Related, and Non-Liver-Related Mortality Among HCV-Infected Individuals in the General US Population
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DOI：
10.1093/cid/cir306
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发表时间：
2011-07-15
影响因子：
11.8
通讯作者：
Shardell, Michelle D.
中科院分区：
文献类型：
--
作者：
El-Kamary, Samer S.;Jhaveri, Ravi;Shardell, Michelle D.
背景丙型肝炎病毒（HCV）感染者的肝脏相关死亡率已被描述，但对非肝脏相关死亡率知之甚少。我们的目的是确定美国普通人群中HCV相关的全因、肝脏和非肝脏相关死亡率。利用2010年公布的第三次全国健康和营养检查调查（NHANES III）关联死亡率文件，对9378名年龄在17-59岁之间的全国代表性成年人进行了前瞻性队列研究。HCV状态评估从1988年到1994年，死亡率随访相同的个人，直到2006年。在中位随访14.8年期间，有614人死亡。调整所有协变量风险因素后，HCV慢性感染的全因死亡率比（MRR）高2.37倍。（95%CI：1.28-4.38; P = .008），肝脏相关MRR高出26.46倍（95%CI：8.00-87.48; P <0.001），非肝脏相关的MRR（95%CI：0.77 -4.19; P = 0.18）比HCV阴性高1.79倍。这表示估计有246万17-59岁的美国成年人患有慢性HCV感染，每年估计有31，163例死亡，其中57.8%（95% CI：21.9%-77.2%）可归因于HCV。其中，每年估计有9569例肝脏相关死亡，其中96.2%（95%CI：87.5-98.9%）可归因于HCV。非肝脏相关死亡与HCV状态无显着相关性。结论。慢性HCV全因死亡率是HCV阴性个体的两倍多。这表明，即使考虑到肝脏相关的发病率，慢性HCV感染者的死亡风险也较高，应密切监测。
Background. Liver-related mortality among those infected with hepatitis C virus (HCV) has been described, but little is known about non-liver-related mortality. Our objective was to determine HCV-associated all-cause, liver-, and non-liver-related mortality in the general US population.Methods. A prospective cohort study of 9378 nationally representative adults aged 17-59 years was performed utilizing the Third National Health and Nutrition Examination Survey (NHANES III) Linked Mortality File that was made publicly available in 2010. HCV status was assessed from 1988 to 1994, with mortality follow-up of the same individuals through 2006.Results. There were 614 deaths over a median follow-up of 14.8 years. After adjusting for all covariate risk factors, HCV chronic infection had a 2.37 times higher all-cause mortality rate ratio [MRR] (95% CI: 1.28-4.38; P = .008), a 26.46 times higher liver-related MRR (95% CI: 8.00-87.48; P < .001), and 1.79 times higher non-liver-related MRR (95% CI:.77-4.19; P = .18), compared with being HCV-negative. This represents an estimated 2.46 million US adults aged 17-59 years with chronic HCV infection who had an estimated 31,163 deaths from all causes per year, of which 57.8% (95% CI: 21.9%-77.2%) were attributable to HCV. Among those, there was an estimated 9569 liver-related deaths per year, of which 96.2% (95% CI: 87.5-98.9%) were attributable to HCV. Non-liver-related deaths were not significantly associated with HCV status.Conclusions. Chronic HCV all-cause mortality is more than twice that of HCV-negative individuals. This suggests that those with chronic HCV infection are at a higher risk of death even after accounting for liver-related morbidity and should be closely monitored.