Hepatitis C and hepatitis B-related mortality in Spain.
BACKGROUND
Although hepatitis C and hepatitis B virus (HCV/HBV) infections are an important health problem worldwide, their burden of disease (BoD) taking into account their chronic consequences, cirrhosis, and hepatocellular carcinoma (HCC), is still unknown. Our aim was to assess the total number of deaths attributable to these viruses in Spain and the years of life lost, first component of the disability adjusted life years, a comparative index of BoD.


METHODS
We selected the International Classification of Diseases-Tenth Revision specific codes related to HCV/HBV. For unspecified cirrhosis and HCC, the attributable fraction of mortality was assessed in two steps: literature review and expert panel. Deaths in Spain in 2000 were obtained from the National Statistics Institute. Years of life lost were calculated using the estimated mortality and life expectancies (Princeton Model Life Table).


RESULTS
HCV could have caused around 70% of HCC deaths and 50% of cirrhosis mortality in Spain in 2000 (60% HCC, 40% cirrhosis with HCV lower estimate). For HBV these proportions are 10 and 13%, respectively. We estimated 4342 HCV-related deaths and 877 HBV-related deaths in Spain in 2000, globally 1.5% of total deaths in Spain that year. Mortality by cirrhosis and HCC represented most of these viral-related deaths. Attributable mortality in AIDS patients was also estimated.


CONCLUSIONS
HCV leads the list of infectious disease-related mortality in Spain in 2000, doubling the AIDS mortality even if lower HCV attributable fractions are considered. Exclusion of cirrhosis and HCC-related mortality severely underestimates the BoD attributable to HCV/HBV. Improving early diagnosis and access to treatment could have an important impact on mortality because of hepatitis virus in the next decades.
Epidemiology Department, Regional Health Council, Murcia, Spain. anam.garcia9@carm.es
Ana
A
García-Fulgueiras
Rocío
R
García-Pina
Consuelo
C
Morant
Visitación
V
García-Ortuzar
Ricard
R
Génova
Elena
E
Alvarez
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000401:mortality* / Q000821:virology; D002648:Child; D002675:Child, Preschool; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications / Q000453:epidemiology / Q000401:mortality*; D019698:Hepatitis C, Chronic / Q000150:complications / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D007223:Infant; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000401:mortality* / Q000821:virology; D008113:Liver Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000821:virology; D008297:Male; D008875:Middle Aged; D017678:Sex Distribution; D013030:Spain / Q000453:epidemiology; D055815:Young Adult