Endemic hepatitis B virus infection and chronic liver disease mortality in the Republic of Palau, 1990-2002.
In the Republic of Palau, a Pacific island nation, approximately 20% of the population is chronically infected with hepatitis B virus (HBV) and is at risk of developing chronic liver disease (CLD), including cirrhosis and hepatocellular carcinoma (HCC). To examine the consequences of HBV infection, we sought to quantify HBV-related CLD mortality in this population. The cause of death was abstracted from death certificates of all persons who died in Palau during 1990-2002. CLD deaths were categorised as cirrhosis or HCC. HBV serological status was determined by review of a hospital database. The cause of death was determined for 1,366 (85%) of 1,608 deaths. CLD was the fifth most common cause of death, accounting for 102 (7%) deaths with a known cause. Of deaths due to CLD, 55 (54%) were from cirrhosis and 47 (46%) were from HCC. Sixty-five percent of CLD decedents and 19% of non-CLD decedents were chronically infected with HBV (P<0.01). The attributable fraction of HBV-related CLD was 54% (58% for cirrhosis and 53% for HCC). CLD mortality rates were approximately twice the worldwide CLD rate. HBV-related CLD is a common cause of death in the Republic of Palau, highlighting the importance of routine infant hepatitis B vaccination, especially in countries with high endemicity.
Vogt
Tara M
TM
Division of Viral Hepatitis, Centers for Disease Control and Prevention, MS G37, Atlanta, GA 30333, USA. tcv3@cdc.gov
Goldstein
Susan T
ST
Kuartei
Stevenson
S
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality*; D002908:Chronic Disease; D019353:Endemic Diseases / Q000706:statistics & numerical data; D005260:Female; D019694:Hepatitis B, Chronic / Q000401:mortality*; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality*; D008113:Liver Neoplasms / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D010139:Pacific Islands / Q000453:epidemiology; D017678:Sex Distribution; D015996:Survival Rate