Confluence of Epidemics of Hepatitis C, Diabetes, Obesity, and Chronic Kidney Disease in the United States Population.
Confluence of Epidemics of Hepatitis C, Diabetes, Obesity, and Chronic Kidney Disease in the United States Population.
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DOI：
10.1016/j.cgh.2017.04.046
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发表时间：
2017-12
期刊：
影响因子：
--
通讯作者：
Selvin E
中科院分区：
文献类型：
--
作者：
Lazo M;Nwankwo C;Daya NR;Thomas DL;Mehta SH;Juraschek S;Willis K;Selvin E
肥胖、肾脏疾病和糖尿病是可能影响慢性丙型肝炎患者预后的常见疾病。我们的目的是量化美国慢性丙型肝炎成人中这些共病的负担，并估计慢性丙型肝炎和共病患者的死亡风险。我们对第三次全国健康和营养检查调查（NHANES III）的13，726名参与者和1999-2012年NHANES的23，691名参与者进行了横断面和前瞻性分析。分析血清样本是否存在丙型肝炎病毒抗体（抗HCV）;在发现抗HCV阳性的样本中，我们定量HCV RNA（病毒载量）。具有抗HCV和可检测到HCV RNA的个体被认为患有慢性丙型肝炎。使用自我报告、体格检查和实验室数据（如可用）定义合并症。我们使用logistic模型和预测边界来估计慢性丙型肝炎患者合并症的校正患病率。我们使用Poisson回归模型来估计基于慢性丙型肝炎状态（有或无合并症）的校正死亡率。考克斯比例风险回归模型，根据慢性丙型肝炎状态（伴或不伴合并症）估计全因、心血管和癌症死亡率的校正风险比和95% CI。在慢性丙型肝炎患者中，经人口统计学调整的糖尿病患病率估计值为17.9%（95%CI，11.2-27.5），肥胖患病率估计值为20.9%（95%CI，12.4-29.5）。总体而言，69.6%的慢性丙型肝炎患者至少有1种主要心脏代谢合并症（95% CI，62.1%-76.2%）。只有38%的慢性丙型肝炎成年人报告了肝脏疾病的诊断。慢性丙型肝炎与死亡风险显著增加相关（风险比，2.45），特别是在糖尿病（风险比，3.24）或慢性肾脏疾病（风险比，4.39）的情况下。在对NHANES数据的分析中，我们发现慢性丙型肝炎患者的主要心脏代谢合并症负担很高。特别是糖尿病和慢性肾脏疾病与慢性丙型肝炎患者的死亡率大幅增加有关。
Obesity, kidney disease, and diabetes are common conditions that can affect outcomes of patients with chronic hepatitis C. We aimed to quantify the burden of these comorbid conditions among adults with chronic hepatitis C in the United States and to estimate the risk of death among people with chronic hepatitis C and comorbidities. We conducted cross-sectional and prospective analyses of 13,726 participants in the third National Health and Nutrition Examination Survey (NHANES III) and 23,691 participants of NHANES 1999–2012. Serum samples were analyzed for the presence of antibodies to hepatitis C virus (anti-HCV); in samples found to be positive for anti-HCV, we quantified HCV RNA (viral load). Individuals with anti-HCV and detectable HCV RNA were considered to have chronic hepatitis C. Comorbidities were defined using self-reported, physical examination, and laboratory data, as available. We used logistic models and predictive margins to estimate the adjusted prevalence of comorbidities in patients with chronic hepatitis C. We used Poisson regression models to estimate adjusted mortality rates based on chronic hepatitis C status, with or without comorbidities. Cox proportional hazard regression models to estimate adjusted hazards ratios and 95% CIs of all-cause, cardiovascular, and cancer mortality according to chronic hepatitis C status, with and without comorbidities. Among persons with chronic hepatitis C, the demographic-adjusted prevalence estimate of diabetes was 17.9% (95% CI, 11.2–27.5) and of obesity was 20.9% (95% CI, 12.4–29.5). Overall, 69.6% of persons with chronic hepatitis C had at least 1 major cardiometabolic comorbidity (95% CI, 62.1%–76.2%). Only 38% of adults with chronic hepatitis C reported a diagnosis of liver disease. Chronic hepatitis C was associated with a substantially increased risk of death (hazard ratio, 2.45), especially in the presence of diabetes (hazard ratio, 3.24) or chronic kidney disease (hazard ratio, 4.39). In an analysis of NHANES data, we found that individuals with chronic hepatitis C have a high burden of major cardiometabolic comorbidities. Diabetes and chronic kidney disease, in particular, are associated with substantial excess mortality in persons with chronic hepatitis C.
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