title: Contribution of alcohol use disorders on the burden of chronic hepatitis C in France, 2008-2013: A nationwide retrospective cohort study.
abstract: Hepatitis C virus (HCV) patients are at risk of alcohol use disorders (AUDs). We measured the contribution of AUDs on the burden of chronic HCV infection in French HCV patients.
  
  
  
  The hospital trajectory of 97,347 French HCV patients aged 18-65 in January 2008 were tracked and followed until in-hospital death or December 2013. Primary outcome was the frequency of liver-related complications. Secondary outcomes were the frequency of liver transplantation and otherwise cause-specific mortality. Adjusted odds ratios (OR), population attributable risks of AUDs and other cofactors of liver disease progression associated with HCV transmission were measured.
  
  
  
  The 28,101 (28.9%) individuals with AUDs had the highest odds for liver-related complications (OR=7.19; 95% confidence interval [CI], 6.90 to 7.50), liver transplantation (OR=4.28; 95% CI, 3.80 to 4.82), and liver death (OR=6.20; 95% CI, 5.85 to 6.58). Alcohol rehabilitation and abstinence were associated with 60% (95% CI, 57% to 63%) and 78% (95% CI, 76% to 80%) reduction of liver-related complications, respectively. The attributable risk of AUDs was 71.8% (95% CI, 66.0 to 76.8) of 17,669 liver-related complications, 67.4% (95% CI, 61.6 to 72.4) of 1,599 liver transplantations, and 68.8% (95% CI, 63.4 to 73.5) of 6,677 liver deaths. The number of liver transplantations remained stable and the number of liver deaths increased, at a faster rate for individuals with AUDs, over the observational period.
  
  
  
  In France, AUDs contributed to more than two-thirds of the burden of chronic HCV infection in young and middle-aged adults over 2008-2013.
  
  
  
  This study tracked liver-related complications and mortality of all 97,347 young and middle-aged patients (18-65years old) discharged with chronic HCV infection from French hospitals over 2008-2013. About 30% patients were recorded with alcohol use disorders (AUDs) and had the highest odds for liver-related complications (i.e. decompensated cirrhosis and liver cancer). AUDs contributed to more than two-thirds of 1,599 liver transplantations and 6,677 liver deaths recorded in patients with chronic HCV infection over 2008-2013 in France. Alcohol rehabilitation and abstinence were associated with above a 50% risk reduction of liver-related complications. Promoting alcohol abstinence should receive high priority to reduce the burden of chronic HCV infection.
authors.affiliation: Translational Health Economics Network (THEN), Paris, France; Infection Antimicrobials Modeling & Evolution (IAME), UMR 1137, Institut National de la Santé et de la Recherche Médicale (INSERM) - Université Paris Diderot, Sorbonne Paris Cité, France. Electronic address: michael.schwarzinger@transhealthecon.net.
authors.forename: Michaël
authors.initials: M
authors.lastname: Schwarzinger
authors.affiliation: Translational Health Economics Network (THEN), Paris, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Baillot
authors.affiliation: Infection Antimicrobials Modeling & Evolution (IAME), UMR 1137, Institut National de la Santé et de la Recherche Médicale (INSERM) - Université Paris Diderot, Sorbonne Paris Cité, France; Service des Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, Assistance Publique - Hôpitaux de Paris, Paris, France.
authors.forename: Yazdan
authors.initials: Y
authors.lastname: Yazdanpanah
authors.affiliation: Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Canada; Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Institute of Medical Science, University of Toronto, Faculty of Medicine, Medical Sciences Building, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Rehm
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Institut Pasteur, Institut National de la Santé et de la Recherche Médicale (Inserm), Unité 1223, Paris, France; Hepatology Service, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Cochin Port-Royal, Paris, France. Electronic address: vincent.mallet@aphp.fr.
authors.forename: Vincent
authors.initials: V
authors.lastname: Mallet
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000150:complications*; D018450:Disease Progression; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000401:mortality / Q000601:surgery; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors
keywords: Alcohol use disorders; Burden of disease; Chronic hepatitis C; Cirrhosis; Disease progression; End-stage liver disease; Hepatocellular carcinoma; Mortality; Natural history; Prognosis