title: Mortality in hepatitis C patients who achieve a sustained viral response compared to the general population.
abstract: The number of people living with previous hepatitis C infection that have attained a sustained viral response (SVR) is expected to grow rapidly. So far, the prognosis of this group relative to the general population is unclear.
  
  
  
  Individuals attaining SVR in Scotland in 1996-2011 were identified using a national database. Through record-linkage, we obtained cause-specific mortality data complete to Dec 2013. We calculated standardised mortality ratios (SMRs) to compare the frequency of mortality in SVR patients to the general population. In a parallel analysis, we used Cox regression to identify modifiable patient characteristics associated with post-SVR mortality.
  
  
  
  We identified 1824 patients, followed on average for 5.2years after SVR. In total, 78 deaths were observed. Overall, all-cause mortality was 1.9 times more frequent for SVR patients than the general population (SMR: 1.86; 95% confidence interval (CI): 1.49-2.32). Significant cause-specific elevations were seen for death due to primary liver cancer (SMR: 23.50; 95% CI: 12.23-45.16), and death due to drug-related causes (SMR: 6.58, 95% CI: 4.15-10.45). Together these two causes accounted for 66% of the total excess death observed. All of the modifiable characteristics associated with increased mortality were markers either of heavy alcohol use or injecting drug use. Individuals without these behavioural markers (32.8% of cohort) experienced equivalent survival to the general population (SMR: 0.70; 95% CI: 0.41-1.18) CONCLUSIONS: Mortality in Scottish SVR patients is higher overall than the general population. The excess was driven by death from drug-related causes and liver cancer. Health risk behaviours emerged as important modifiable determinants of mortality in this population.
  
  
  
  Patients cured of hepatitis C through treatment had a higher mortality rate overall than the general population. Most of the surplus mortality was due to drug-related causes and death from liver cancer. A history of heavy alcohol and injecting drug use were associated with a higher mortality risk.
authors.affiliation: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK. Electronic address: hamish.innes@nhs.net.
authors.forename: Hamish
authors.initials: H
authors.lastname: Innes
authors.affiliation: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK.
authors.forename: Scott
authors.initials: S
authors.lastname: McDonald
authors.affiliation: Royal Infirmary Edinburgh, Edinburgh, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Hayes
authors.affiliation: Ninewells Hospital and Medical School, Dundee, UK.
authors.forename: John F
authors.initials: JF
authors.lastname: Dillon
authors.affiliation: University Hospital, Crosshouse, UK.
authors.forename: Sam
authors.initials: S
authors.lastname: Allen
authors.affiliation: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK.
authors.forename: David
authors.initials: D
authors.lastname: Goldberg
authors.affiliation: Gartnavel General Hospital, Glasgow, UK.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Mills
authors.affiliation: Glasgow Royal Infirmary, Glasgow, UK.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Barclay
authors.affiliation: Western General Hospital, Edinburgh, UK.
authors.forename: David
authors.initials: D
authors.lastname: Wilks
authors.affiliation: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Valerio
authors.affiliation: The Brownlee Centre, Glasgow, UK.
authors.forename: Ray
authors.initials: R
authors.lastname: Fox
authors.affiliation: Kirkcaldy Hospital, Fife, UK.
authors.forename: Diptendu
authors.initials: D
authors.lastname: Bhattacharyya
authors.affiliation: Monklands Hospital, Lanarkshire, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Kennedy
authors.affiliation: Southern General Hospital, Glasgow, UK.
authors.forename: Judith
authors.initials: J
authors.lastname: Morris
authors.affiliation: Aberdeen Royal Infirmary, Aberdeen, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Fraser
authors.affiliation: Glasgow Royal Infirmary, Glasgow, UK.
authors.forename: Adrian
authors.initials: A
authors.lastname: Stanley
authors.affiliation: Stirling Royal Infirmary, Stirling, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Bramley
authors.affiliation: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK.
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Hutchinson
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use; D002423:Cause of Death; D016208:Databases, Factual; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy / Q000401:mortality / Q000821:virology; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011379:Prognosis; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D000072230:Sustained Virologic Response
chemical_list: D000998:Antiviral Agents
keywords: Cure; Epidemiology; Excess mortality; Hepatitis C