title: Trends in mortality after diagnosis of hepatitis C virus infection: an international comparison and implications for monitoring the population impact of treatment.
abstract: OBJECTIVE
  People living with hepatitis C virus (HCV) are at increased risk of all-cause and liver-related mortality, although successful treatment has been shown to reduce this risk. The aim of this study was to provide baseline data on trends in cause-specific mortality and to establish an international surveillance system for evaluating the population level impact of HCV treatments.
  
  
  METHODS
  Population level HCV diagnosis databases from Scotland (1997-2010), Australia (New South Wales [NSW]) (1997-2006), and Canada (British Columbia [BC]) (1997-2003) were linked to corresponding death registries using record linkage. For each region, age-adjusted cause-specific mortality rates were calculated, and trends in annual age-adjusted liver-related mortality were plotted.
  
  
  RESULTS
  Of 105,138 individuals diagnosed with HCV (21,810 in Scotland, 58,484 in NSW, and 24,844 in BC), there were 7275 deaths (2572 in Scotland, 2655 in NSW, and 2048 in BC). Liver-related deaths accounted for 26% of deaths in Scotland, 21% in NSW, and 22% in BC. Temporal trends in age-adjusted liver related mortality were stable in Scotland (males p=0.4; females p=0.2) and NSW (males p=0.9; females p=0.9), while there was an increase in BC (males p=0.002; females p=0.04).
  
  
  CONCLUSIONS
  The risk of liver-related mortality after a diagnosis of HCV has remained stable or increased over time across three regions with well-established diagnosis databases, highlighting that HCV treatment programmes to-date have had minimal impact on population level HCV-related liver disease. With more effective therapies on the horizon, and greater uptake of treatment anticipated, the potential of future therapeutic strategies to reduce HCV-related mortality is considerable.
authors.affiliation: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, National Services Scotland, Glasgow, UK; The Kirby Institute, University of New South Wales, Sydney, Australia. Electronic address: Esther.Aspinall@nhs.net.
authors.forename: Esther J
authors.initials: EJ
authors.lastname: Aspinall
authors.affiliation: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, National Services Scotland, Glasgow, UK.
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Hutchinson
authors.affiliation: British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Naveed Z
authors.initials: NZ
authors.lastname: Janjua
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, Australia.
authors.forename: Jason
authors.initials: J
authors.lastname: Grebely
authors.affiliation: British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Amanda
authors.initials: A
authors.lastname: Yu
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, Australia.
authors.forename: Maryam
authors.initials: M
authors.lastname: Alavi
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, Australia.
authors.forename: Janaki
authors.initials: J
authors.lastname: Amin
authors.affiliation: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, National Services Scotland, Glasgow, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Goldberg
authors.affiliation: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, National Services Scotland, Glasgow, UK.
authors.forename: Hamish
authors.initials: H
authors.lastname: Innes
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Law
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, Australia; The Australian Institute of Health Innovation, University of New South Wales, Sydney, Australia.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Walter
authors.affiliation: British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Mel
authors.initials: M
authors.lastname: Krajden
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, Australia.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Dore
mesh_terms: D000328:Adult; D017677:Age Distribution; D000998:Antiviral Agents / Q000627:therapeutic use*; D001955:British Columbia / Q000453:epidemiology; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D055815:Young Adult
chemical_list: D000998:Antiviral Agents
keywords: Hepatitis C; Hepatitis C therapies; Liver-related mortality