Theme: Epidemiology & Public Health Research Year: 2024
Background: The World Health Organization aims to eliminate viral hepatitis by 2030, targeting hepatitis C virus (HCV)-related deaths to ≤2 per 100,000 population. While recent evidence report reduced HCV-related morbidity and mortality, overall mortality rates among HCV-notified individuals remain high, suggesting potential unaddressed comorbidities despite direct-acting antiviral (DAA) availability. This population-based study examined cause-specific mortality trends among individuals with HCV notification in New South Wales (NSW), Australia, during the viral hepatitis elimination era (January 1, 2015 – 30 December 2021).
Methods: HCV notifications in NSW, Australia (1995-2022) were linked to hospitalisation records and linked cause-specific mortality records. Mortality trends during the elimination era were examined. Cox proportional hazard models were used to assess associated factors with mortality during the viral hepatitis elimination era.
Results: During 2002-2021, there were 112,046 people with an HCV notification in NSW.
During the elimination era (2015-2021), the all-cause mortality rate was 119.7 per 10,000 person-years (PY). Cause-specific mortality rates per 10,000 PY were: liver-related (27.7), drug-related (19.0), circulatory system-related (15.8), cancer-related (23.9), and other cause-related (33.1). Standardised mortality ratios (SMRs) were elevated for liver-related (18.7, 95% CI 17.8-19.6), drug-related (33.3, 95% CI 31.4-35.3), circulatory system-related (1.2, 95% CI 1.2-1.3), cancer-related (1.8, 95% CI 1.7-1.9), and other cause-related deaths (2.3, 95% CI 2.2-2.4). Factors associated with mortality during the elimination era included: recent injecting drug use (adjusted Hazard Ratio [aHR] 7.22, 95% CI 6.84-7.62), recent alcohol use disorder (aHR 3.17, 95% CI 2.97-3.37), and Charlson comorbidity index 3+ (aHR 4.42, 95% CI 4.17-4.69). Recent opioid agonist therapy (aHR 0.47, 95% CI 0.43-0.51) was associated with lower mortality risk.
Conclusion: Despite advancements in HCV treatment, individuals with HCV in NSW continue to experience elevated mortality risks. Understanding trends are crucial for addressing preventable deaths and improving health outcomes in the viral hepatitis elimination era.