Theme: Epidemiology & Public Health Research Year: 2017
Introduction: We report the causes of death by birth cohort among HCV-infected people to understand the relative contributions of HCV acquisition risks, viral sequelae, and other mortality causes.
Methods: The BC-HTC includes individuals tested for HCV or reported to public health as a HCV case from 1990-2013 linked to their corresponding administrative data. ICD-10 codes were used to classify mortality as: 1) liver-related (including decompensated liver disease, liver cancer, HCV, HIV-related, non-alcoholic and alcoholic liver disease, other types of hepatitis); 2) acquisition risk-related (including drug-related); and 3) all other mortality causes. We computed mortality proportions by birth cohort: born <1945, 1945-64 and ≥1965. Results: Of 1,135,947 individuals in the BC-HTC, 67,726 (6.0%) were HCV positive. Overall, 17.6% (11,945/67,726) of HCV positive vs. 7.5% (79,840/1,068,221) of HCV negative individuals died. Median age at death was 55 vs. 74 yr., respectively. Causes of death for the <1945, 1945-64 and ≥1965 birth cohorts, respectively, were: 1) liver-related: 5.8% (3,591/61,578), 17.7% (4,239/23,984) and 9.8% (610/6,223); 2) acquisition risk-related: 0.2% (127/61,578), 6.1% (1,464/23,984) and 18.9% (1,173/6,223); and 3) all other mortality causes: 94.0% (57,860/61,578), 76.2% (18,281/23,984) and 71.4% (4,440/6,223). In summary, compared to the ≥1965 birth cohort, the 1945-64 cohort had a lower proportion of deaths due to HCV acquisition risks (18.9% vs. 6.1%) but a higher proportion of liver-related deaths (9.8% vs. 17.7%). Conclusions: HCV acquisition risks combined with viral sequelae reduced the median lifespan by 19 yr. Those born ≥1965 were more likely to die from HCV acquisition risks than from HCV infection sequelae, whereas the opposite was true for the 1945-64 cohort. Curative HCV treatment, while likely to reduce deaths from HCV viral sequelae, will not reduce acquisition risk mortality, confirming the need for comprehensive harm reduction programming to reduce overall mortality.Download abstract