title: Impact of hepatitis C virus infection on all-cause and liver-related mortality in a large community-based cohort of inner city residents.
abstract: The aim of this study was to measure the impact of hepatitis C virus (HCV) infection on mortality in a cohort of inner city residents. The Community Health and Safety Evaluation is a community-based study of inner city residents followed retrospectively and prospectively through linkages with provincial virology and mortality databases. We identified participants having received HCV antibody testing, evaluated cause-specific mortality rates and factors associated with all-cause and liver-related mortality using Cox Proportional Hazards models. Overall, 2332 participants received HCV antibody testing (recent non-injection drug use - 81%). The prevalence of HCV and HIV was 64% (1495 of 2332) and 21% (485 of 2332), respectively. Between January 2003 and December 2007, there were 180 deaths (192 per 10.000 person-years; 95% CI: 165, 222), with 21% HIV-related, 20% drug-related and 7% liver-related. Mortality was associated with age >50 [adjusted hazard ratio (AHR) 2.80 vs < 40 years (referent group); 95% CI 1.93, 4.07, P < 0.001] and HIV infection (AHR 3.81; 95% CI 2.72, 5.34, P < 0.001), but not positive HCV antibody status (AHR 1.19; 95% CI 0.83, 1.72, P = 0.35). Liver-related mortality was associated with age >50 [AHR 18.49 vs < 40 years (referent group); 95% CI 2.27, 150.41, P < 0.001] and positive HCV antibody status (AHR 7.69; 95% CI 0.99, 59.98, P = 0.052). This study demonstrates a high rate of mortality in this population, particularly those with HIV. HCV-infected inner city residents >50 years of age were at significant risk of liver-related mortality. Continued surveillance of this population infected with HCV in the 1970s and 1980s is important.
authors.affiliation: National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney, NSW, Australia. jgrebely@nchecr.unsw.edu.au
authors.forename: J
authors.initials: J
authors.lastname: Grebely
authors.forename: J D
authors.initials: JD
authors.lastname: Raffa
authors.forename: C
authors.initials: C
authors.lastname: Lai
authors.forename: T
authors.initials: T
authors.lastname: Kerr
authors.forename: B
authors.initials: B
authors.lastname: Fischer
authors.forename: M
authors.initials: M
authors.lastname: Krajden
authors.forename: G J
authors.initials: GJ
authors.lastname: Dore
authors.forename: M W
authors.initials: MW
authors.lastname: Tyndall
mesh_terms: D000328:Adult; D001955:British Columbia / Q000453:epidemiology; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology / Q000401:mortality*; D006526:Hepatitis C / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality*; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D019966:Substance-Related Disorders / Q000150:complications / Q000453:epidemiology / Q000401:mortality*; D016019:Survival Analysis; D014505:Urban Population / Q000706:statistics & numerical data
chemical_list: D018937:Hepatitis C Antibodies