title: Causes of death in people with chronic HBV infection: A population-based cohort study.
abstract: OBJECTIVE
  Mortality related to hepatitis B virus (HBV) is not well known in developed countries. The aim of this study was to investigate in a population-based cohort the excess risk of death in HBV patients compared with mortality in the general population and to identify risk factors related to all-cause mortality and HBV-related mortality.
  
  
  METHODS
  A specialized population-based registry has recorded data from patients with chronic HBV infection in a population of one million inhabitants in France since 1994. Standardized mortality rates for all-cause death and HBV-related death were calculated. Cumulative mortality rates were calculated using the Kaplan-Meier method. Multivariate analysis was performed using a Cox model.
  
  
  RESULTS
  Between 1994 and 2009, 1117 people were diagnosed with chronic HBV infection. Of these 136 (12.2%) died. All-cause mortality was significantly higher in HBV-infected people (standardized mortality ratio (SMR) 1.7 [1.4-2.0]). There was substantial excess mortality due to hepatocellular carcinoma (SMR 15.9 [10-24.1]), non-Hodgkin lymphoma (SMR 8.6 [3.1-18.6]) and liver disease (SMR 10.2 [5.8-16.6]). The cumulative rates for all-cause mortality were 8.6% at 5 years, 12.6% at 10 years and 18.5% at 15 years. The corresponding values for HBV-related mortality were 3.5%, 4.2%, and 5.8%. The multivariate analysis for all-cause mortality and for HBV-related mortality showed that male sex, age over 45 at diagnosis, current alcoholism and nosocomial risk factors were predictors of increased mortality.
  
  
  CONCLUSIONS
  This study shows increased all-cause mortality in HBsAg-positive patients, with considerable excess mortality due to chronic liver disease, hepatocellular carcinoma and non-Hodgkin lymphoma.
authors.affiliation: Department of Hepatogastroenterology, Dijon University Hospital, BP 87900, 21079 Dijon, France. Electronic address: c.montuclard@hotmail.fr.
authors.forename: Celine
authors.initials: C
authors.lastname: Montuclard
authors.affiliation: Burgundy University, France; Department of Hepatogastroenterology, Dijon University Hospital, BP 87900, 21079 Dijon, France.
authors.forename: Samia
authors.initials: S
authors.lastname: Hamza
authors.affiliation: Viral Hepatitis Registry, INSERM U866, France; Burgundy University, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Rollot
authors.affiliation: Viral Hepatitis Registry, INSERM U866, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Evrard
authors.affiliation: Burgundy University, France; Department of Hepatogastroenterology, Dijon University Hospital, BP 87900, 21079 Dijon, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Faivre
authors.affiliation: Viral Hepatitis Registry, INSERM U866, France; Burgundy University, France; Department of Hepatogastroenterology, Dijon University Hospital, BP 87900, 21079 Dijon, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Hillon
authors.affiliation: Intensive Care and Hepatology Unit, University Hospital of Besançon, 25000, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Di Martino
authors.affiliation: Viral Hepatitis Registry, INSERM U866, France; Burgundy University, France; Department of Hepatogastroenterology, Dijon University Hospital, BP 87900, 21079 Dijon, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Minello
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D019694:Hepatitis B, Chronic / Q000150:complications / Q000401:mortality*; D006801:Humans; D008107:Liver Diseases / Q000150:complications / Q000401:mortality; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality; D008228:Lymphoma, Non-Hodgkin / Q000150:complications / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors; D055815:Young Adult
keywords: Cohort; Epidemiology; France; Hepatitis B virus; Mortality; Population-based