Mortality after chronic hepatitis B virus infection: a linkage study involving 2 million parous women from Taiwan.
BACKGROUND
Few studies have evaluated survival rates among women who have chronic hepatitis B virus infection. We investigated the overall and disease-specific mortality rates in a nationwide cohort of women after they were screened for hepatitis B surface antigen (HBsAg) during pregnancy.


METHODS
HBsAg prenatal screening data were available for 2,087,994 women in Taiwan between 1 January 1986 and 31 March 2000 in the National Hepatitis B Vaccination Registry. Their vital status and cause of death were ascertained by computerized linkage with the National Death Certification Registry. Cox proportional hazards models were used to estimate the association between HBsAg status and specific causes of death.


RESULTS
Overall, 14,524 deaths were identified after a mean of 11.43 years of follow-up. The age-adjusted hazard ratio for mortality among HBsAg carriers compared with noncarriers was 1.24 (95% confidence interval [CI], 1.19-1.30), 6.59 (95% CI, 5.70-7.61), and 1.09 (95% CI, 1.04-1.14) for all-cause, liver-specific, and non-liver-related deaths, respectively. In addition to liver-specific causes, a significantly increased risk of mortality from non-Hodgkin lymphoma (P < .001) and gallbladder and extrahepatic bile duct cancer (P = .01) was observed.


CONCLUSIONS
Our study found an excess risk of death due to both liver-specific and non-liver-related causes for HBsAg-positive women in Taiwan. Effective prevention and treatment of hepatitis B virus infection is an important public health priority.
Fwu
Chyng-Wen
CW
Johns Hopkins University, Baltimore, Maryland, USA.
Chien
Yin-Chu
YC
Nelson
Kenrad E
KE
Kirk
Gregory D
GD
You
San-Lin
SL
Kuo
Hsu-Sung
HS
Feinleib
Manning
M
Chen
Chien-Jen
CJ
D000328:Adult; D015331:Cohort Studies; D005260:Female; D006508:Hepatitis Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000276:immunology; D006515:Hepatitis B virus / Q000302:isolation & purification; D019694:Hepatitis B, Chronic / Q000097:blood / Q000276:immunology / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D009035:Mothers; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood / Q000453:epidemiology; D015995:Prevalence; D016016:Proportional Hazards Models; D018570:Risk Assessment; D013624:Taiwan / Q000453:epidemiology
D006508:Hepatitis Antibodies; D006514:Hepatitis B Surface Antigens