title: Excess mortality rates in a cohort of patients infected with the hepatitis C virus: a prospective study.
abstract: OBJECTIVE
  We analysed the Trent Hepatitis C cohort to determine standardised mortality ratios in patients infected with hepatitis C virus (HCV), and to identify risk factors and associations with all-cause and liver-related mortality.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Patients with HCV infection attending secondary care within the Trent region of England.
  
  
  METHODS
  2285 patients with hepatitis C, followed for 1 year or more.
  
  
  METHODS
  The death rate in the cohort was compared to that seen in an age- and sex-matched English population. We performed Cox regression analyses to identify factors predictive of all-cause mortality and deaths from liver disease.
  
  
  RESULTS
  Standardised mortality ratios in the cohort were three times higher than those expected in the general population of England. The excess deaths were due to liver-related causes and those associated with a drug-using lifestyle. Significant independent predictors of all-cause mortality were age, sex, treatment (protective) and liver biopsy fibrosis. Age, treatment, liver biopsy fibrosis and mean alcohol consumption were predictors of liver-related mortality. HCV was mentioned on 23% of death certificates overall, and on 52% of those of patients dying from a liver-related cause.
  
  
  CONCLUSIONS
  Our findings demonstrate that the death rate in patients infected with hepatitis C is three times higher than expected. Severity of disease is associated with a worse prognosis, whilst treatment improves outcome, particularly in those who respond. Use of death certificate data on HCV infection for planning purposes will result in considerable under-estimation of the HCV-related disease burden.
authors.affiliation: Department of Epidemiology and Public Health, University of Nottingham, UK.
authors.forename: Keith R
authors.initials: KR
authors.lastname: Neal
authors.forename: Sheena
authors.initials: S
authors.lastname: Ramsay
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Thomson
authors.forename: William L
authors.initials: WL
authors.lastname: Irving
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000401:mortality; D002423:Cause of Death; D004739:England / Q000453:epidemiology; D005260:Female; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017678:Sex Distribution