title: Excess mortality rate associated with hepatitis C virus infection: A community-based cohort study in rural Egypt.
abstract: >80% of people chronically infected with hepatitis C virus (HCV) live in resource-limited countries, yet the excess mortality associated with HCV infection in these settings is poorly documented.
  
  
  
  Individuals were recruited from three villages in rural Egypt in 1997-2003 and their vital status was determined in 2008-2009. Mortality rates across the cohorts were compared according to HCV status: chronic HCV infection (anti-HCV antibody positive and HCV RNA positive), cleared HCV infection (anti-HCV antibody positive and HCV RNA negative) and never infected (anti-HCV antibody negative). Data related to cause of death was collected from a death registry in one village.
  
  
  
  Among 18,111 survey participants enrolled in 1997-2003, 9.1% had chronic HCV infection, 5.5% had cleared HCV infection, and 85.4% had never been infected. After a mean time to follow-up of 8.6years, vital status was obtained for 16,282 (89.9%) participants. When compared to those who had never been infected with HCV in the same age groups, mortality rate ratios (MRR) of males with chronic HCV infection aged <35, 35-44, and 45-54years were 2.35 (95% CI 1.00-5.49), 2.87 (1.46-5.63), and 2.22 (1.29-3.81), respectively. No difference in mortality rate was seen in older males or in females. The all-cause mortality rate attributable to chronic HCV infection was 5.7% (95% CI: 1.0-10.1%), while liver-related mortality was 45.5% (11.3-66.4%).
  
  
  
  Use of a highly potent new antiviral agent to treat all villagers with positive HCV RNA may reduce all-cause mortality rate by up to 5% and hepatic mortality by up to 40% in rural Egypt.
authors.affiliation: Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Aya
authors.initials: A
authors.lastname: Mostafa
authors.affiliation: Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Shimakawa
authors.affiliation: Department of Gastroenterology & Tropical Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Medhat
authors.affiliation: Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
authors.forename: Nabiel N
authors.initials: NN
authors.lastname: Mikhail
authors.affiliation: Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France; UMI 233, Institut de Recherche pour le Développement (IRD), Montpellier, France.
authors.forename: Cédric B
authors.initials: CB
authors.lastname: Chesnais
authors.affiliation: Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Naglaa
authors.initials: N
authors.lastname: Arafa
authors.affiliation: Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Iman
authors.initials: I
authors.lastname: Bakr
authors.affiliation: Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Mostafa
authors.initials: M
authors.lastname: El Hoseiny
authors.affiliation: Viral Hepatitis Research Laboratory, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt; National Liver Institute, Menoufia University, Menoufia, Egypt.
authors.forename: Mai
authors.initials: M
authors.lastname: El-Daly
authors.affiliation: Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Gamal
authors.initials: G
authors.lastname: Esmat
authors.affiliation: Viral Hepatitis Research Laboratory, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt; Department of Microbiology and Immunology, Faculty of Medicine, Minia University, Minia, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel-Hamid
authors.affiliation: Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Mostafa K
authors.initials: MK
authors.lastname: Mohamed
authors.affiliation: Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France; Département d'Infection et Épidémiologie, Conservatoire National des Arts et Métiers, Paris, France. Electronic address: fontanet@pasteur.fr.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Fontanet
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D002648:Child; D015331:Cohort Studies; D004534:Egypt; D005260:Female; D019698:Hepatitis C, Chronic / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D055815:Young Adult
keywords: Africa; Cohort studies; Egypt; Hepatitis C; Mortality