title: The burden of hepatitis C virus infection is growing: a Canadian population-based study of hospitalizations from 1994 to 2004.
abstract: BACKGROUND
  Nearly 1% of Canadians are infected with the hepatitis C virus (HCV). Simulation analyses have suggested that HCV will place an increasing burden on the health care system as the infected population ages, but supportive clinical data are limited.
  
  
  OBJECTIVE
  To study temporal trends in HCV-related hospitalizations and predictors of increased health care utilization from a Canadian population-based perspective.
  
  
  METHODS
  An administrative hospitalization database from the Calgary Health Region was used to identify patients who were admitted for HCV between 1994 and 2004. The primary outcomes were liver-related HCV hospitalizations, length of stay, hospital costs and in-hospital mortality. Average annual growth rates in outcomes were calculated and subgroup analyses were conducted according to age, sex and HIV/HCV coinfection status.
  
  
  RESULTS
  Between 1994 and 2004, there were 4002 HCV-related hospitalizations; 22% were liver-related. Liver-related hospitalizations, lengths of stay and in-hospital mortality increased approximately fourfold or an average of 15% to 18% annually (P<0.0005). Patients aged 40 to 59 years and HIV/HCV coinfected patients experienced the largest average annual growth rates (19% to 27% and 30% to 40%, respectively; P<0.0005), reflecting the accelerated natural history of HCV in these subgroups. Hospital costs for liver-related HCV hospitalizations increased by an average of 41% annually (P=0.001) between 2000 and 2004. The average annual increase in liver-related hospitalizations remained significant in a sensitivity analysis, even when 75% of HCV cases were under-reported in 1994.
  
  
  CONCLUSIONS
  The present studies' findings confirm the growing burden of HCV on the Canadian health care system. Strategies to prevent HCV infection and maximize the dissemination and most effective use of potentially curative antiviral therapies are necessary to reduce these trends.
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Canada. rpmyers@ucalgary.ca
authors.forename: Robert P
authors.initials: RP
authors.lastname: Myers
authors.forename: MingFu
authors.initials: M
authors.lastname: Liu
authors.forename: Abdel Aziz
authors.initials: AA
authors.lastname: Shaheen
mesh_terms: D000328:Adult; D002170:Canada / Q000453:epidemiology; D017281:Cost of Illness; D005260:Female; D006526:Hepatitis C / Q000191:economics / Q000453:epidemiology* / Q000628:therapy*; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged