title: The contributions of viral hepatitis and alcohol to liver-related deaths in opioid-dependent people.
abstract: BACKGROUND
  Mortality rates are elevated among heroin-dependent populations compared to the general population. Liver disease is emerging as an important contributor to mortality as the heroin-dependent population ages. Two major risk factors for liver disease are hepatitis C virus infection and chronic heavy alcohol use. Both of these are highly prevalent among heroin dependent people, but their relative contribution to liver-related mortality is poorly understood.
  
  
  METHODS
  Data recording all prescriptions of opioid substitution treatment in New South Wales, Australia, 1997-2005, were linked to the National Death Index. Crude and standardised mortality rates and standardised mortality ratios were calculated for liver-related and other major causes of death. Frequency counts were obtained for viral hepatitis and alcohol mentions in underlying liver deaths.
  
  
  RESULTS
  There were 208 underlying liver deaths for a CMR of 72.4 per 100,000 py (95% CI 62.9, 82.9), and liver deaths occurred at 9.8 times the general population rate (95% CI 8.5, 11.2). There were increases in liver-related mortality over time. Viral hepatitis was mentioned in three-quarters (n=156, 76%), and alcohol in 43% (n=90) of underlying liver deaths.
  
  
  CONCLUSIONS
  Liver-related deaths were shown to be increasing in this heroin-dependent population, and the majority of these deaths involved chronic viral hepatitis infection. Increased uptake of treatment for hepatitis C virus infection is crucial to reducing the burden of liver-related mortality in this population. Hepatitis B vaccination, and screening of OST patients for alcohol use disorders and delivery of brief interventions as clinically indicated may also be of benefit.
authors.affiliation: Brown University Medical School, United States. s.larney@unsw.edu.au
authors.forename: Sarah
authors.initials: S
authors.lastname: Larney
authors.forename: Deborah
authors.initials: D
authors.lastname: Randall
authors.forename: Amy
authors.initials: A
authors.lastname: Gibson
authors.forename: Louisa
authors.initials: L
authors.lastname: Degenhardt
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006526:Hepatitis C / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality*; D006556:Heroin Dependence / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality*; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality