title: Hepatitis C virus infection increases the risk of developing peripheral arterial disease: a 9-year population-based cohort study.
abstract: OBJECTIVE
  The relationship between hepatitis C virus (HCV) infection and peripheral arterial disease (PAD) development remains unclear.
  
  
  METHODS
  Health insurance claims data were used to construct a cohort of HCV-infected patients diagnosed during the period 1998-2011. Patients younger than 20 years and those with history of hepatitis B or PAD were excluded. We selected 7641 HCV-infected patients and 30564 matched controls. The adjusted risk of developing PAD was analyzed using a multivariate Cox hazard model.
  
  
  RESULTS
  The results show that the excess risk of PAD development in HCV-infected patients is 1.43-fold higher (95% CI=1.23-1.67) compared with non-HCV patients. The adjusted risk of PAD development increases with age; compared with the 20-34 year-old patients, the risk is 3.96-fold higher in HCV-infected patients aged 35-49 years, and 11.7-fold higher in those aged 65 years and above. CKD/ESRD has the highest risk for PAD (HR=1.80, 95% CI=1.29-2.53). HCV-infected patients with four comorbidities exhibit a substantially higher risk of developing PAD (HR=9.25, 95% CI=6.35-13.5). Excess risk of developing PAD is observed from the first year of follow-up till the third year.
  
  
  CONCLUSIONS
  HCV-infected patients have an independently higher risk of developing PAD. HCV-infected patients with comorbidity have increased risk of developing PAD.
authors.affiliation: Department of Public Health, China Medical University, Taichung City 404, Taiwan; Department of Health Services Administration, China Medical University, Taichung City 404, Taiwan; Department of Internal Medicine, Division of Nephrology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City 600, Taiwan; Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan City 736, Taiwan.
authors.forename: Yueh-Han
authors.initials: YH
authors.lastname: Hsu
authors.affiliation: Management Office for Health Data, China Medical University Hospital, Taichung City 404, Taiwan; School of Medicine, China Medical University, Taichung City 404, Taiwan.
authors.forename: Chih-Hsin
authors.initials: CH
authors.lastname: Muo
authors.affiliation: Department of Public Health, China Medical University, Taichung City 404, Taiwan; Department of Health Services Administration, China Medical University, Taichung City 404, Taiwan.
authors.forename: Chun-Yi
authors.initials: CY
authors.lastname: Liu
authors.affiliation: Department of Public Health, China Medical University, Taichung City 404, Taiwan; Department of Health Services Administration, China Medical University, Taichung City 404, Taiwan.
authors.forename: Wen-Chen
authors.initials: WC
authors.lastname: Tsai
authors.affiliation: Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County 35053, Taiwan; Department of Health Services Administration, China Medical University and Hospital, Taichung City 404, Taiwan.
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Hsu
authors.affiliation: Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung City 404, Taiwan.
authors.forename: Fung-Chang
authors.initials: FC
authors.lastname: Sung
authors.affiliation: Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung City 404, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung City 404, Taiwan. Electronic address: d10040@mail.cmuh.org.tw.
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Kao
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006526:Hepatitis C / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000453:epidemiology / Q000209:etiology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
keywords: Cardiovascular disease; Chronic kidney disease; Comorbidity; Hepatitis; Peripheral arterial disease; Stroke