title: Mortality associated with hepatitis C and hepatitis B virus infection: A nationwide study on multiple causes of death data.
abstract: OBJECTIVE
  To analyze mortality associated with hepatitis C virus (HCV) and hepatitis B virus (HBV) infection in Italy.
  
  
  METHODS
  Death certificates mentioning either HBV or HCV infection were retrieved from the Italian National Cause of Death Register for the years 2011-2013. Mortality rates and proportional mortality (percentage of deaths with mention of HCV/HBV among all registered deaths) were computed by gender and age class. The geographical variability in HCV-related mortality rates was investigated by directly age-standardized rates (European standard population). Proportional mortality for HCV and HBV among subjects aged 20-59 years was assessed in the native population and in different immigrant groups.
  
  
  RESULTS
  HCV infection was mentioned in 1.6% (n= 27730) and HBV infection in 0.2% (n= 3838) of all deaths among subjects aged ≥ 20 years. Mortality rates associated with HCV infection increased exponentially with age in both genders, with a male to female ratio close to unity among the elderly; a further peak was observed in the 50-54 year age group especially among male subjects. HCV-related mortality rates were higher in Southern Italy among elderly people (45/100000 in subjects aged 60-79 and 125/100000 in subjects aged ≥ 80 years), and in North-Western Italy among middle-aged subjects (9/100000 in the 40-59 year age group). Proportional mortality was higher among Italian citizens and North African immigrants for HCV, and among Sub-Saharan African and Asian immigrants for HBV.
  
  
  CONCLUSIONS
  Population ageing, immigration, and new therapeutic approaches are shaping the epidemiology of virus-related chronic liver disease. In spite of limits due to the incomplete reporting and misclassification of the etiology of liver disease, mortality data represent an additional source of information for surveillance.
authors.affiliation: Ugo Fedeli, Epidemiological Department, Veneto Region, 35131 Padova, Italy.
authors.forename: Ugo
authors.initials: U
authors.lastname: Fedeli
authors.affiliation: Ugo Fedeli, Epidemiological Department, Veneto Region, 35131 Padova, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Grande
authors.affiliation: Ugo Fedeli, Epidemiological Department, Veneto Region, 35131 Padova, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Grippo
authors.affiliation: Ugo Fedeli, Epidemiological Department, Veneto Region, 35131 Padova, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Frova
mesh_terms: D000328:Adult; D000367:Age Factors; D002423:Cause of Death; D054242:Emigrants and Immigrants; D005260:Female; D016174:Hepacivirus / Q000302:isolation & purification*; D006514:Hepatitis B Surface Antigens; D006515:Hepatitis B virus / Q000302:isolation & purification*; D019694:Hepatitis B, Chronic / Q000401:mortality* / Q000821:virology; D019698:Hepatitis C, Chronic / Q000401:mortality* / Q000821:virology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012042:Registries / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012737:Sex Factors; D055815:Young Adult
chemical_list: D006514:Hepatitis B Surface Antigens
keywords: Epidemiology; Hepatitis B virus; Hepatitis C virus; Immigrants; Mortality