Amin Janaki, Law Matthew G, Bartlett Mark, Kaldor John M, Dore Gregory J
National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, NSW 2010, Australia.
Lancet. 2006 Sep 9;368(9539):938-45. doi: 10.1016/S0140-6736(06)69374-4.
Hepatitis B and hepatitis C virus infections are common causes of death related to liver disease. In this large study, we aimed to investigate all cause mortality of the viruses in a community-based setting.
In the study population, 39,109 people had hepatitis B, 75,834 had hepatitis C, and 2604 had hepatitis B and hepatitis C co-infection, notified to the New South Wales state health department, Australia, between 1990 and 2002. Their data were probabilistically linked to the National Death Index. Standardised mortality ratios for all causes of death were calculated and adjusted for age, sex, and calendar year.
The number of deaths identified by the linkage were 1233 (3.2%) for hepatitis B, 4008 (5.3)% for hepatitis C, and 186 (7.1)% for hepatitis B and C co-infection. Raised risk of liver-related death (standardised mortality ratios 12.2, 95% CI 10.7-13.9; 16.8, 15.4-18.3, and 32.9, 23.1-46.7, for hepatitis B, hepatitis C, and hepatitis B and C co-infected patients, respectively) and drug-induced death (1.4, 1.0-2.0; 19.3, 18.1-20.5; and 24.7, 18.2-33.5, respectively) were detected. In people with hepatitis C, raised risk of dying from drug-related causes was significantly greater than from liver-related causes (p=0.012), with the greatest excess risk in women aged 15-24 years (56.9, 39.2-79.9).
All groups had increased risk of liver-related death compared with the standard population, with the greatest excess in people diagnosed with hepatitis B and hepatitis C co-infection. Our data highlight that young people with hepatitis C and with co-infection face a higher mortality risk from continued drug use than from their infection, whereas the main cause of hepatitis B death was liver related.
乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）感染是肝病相关死亡的常见原因。在这项大型研究中，我们旨在调查社区环境中这些病毒感染导致的全因死亡率。
研究人群包括1990年至2002年间向澳大利亚新南威尔士州卫生部报告的39109例HBV感染者、75834例HCV感染者以及2604例HBV和HCV合并感染者。他们的数据通过概率链接至国家死亡指数。计算所有死因的标准化死亡率，并对年龄、性别和日历年进行调整。
通过链接确定的死亡人数分别为：HBV感染组1233例（3.2%），HCV感染组4008例（5.3%），HBV和HCV合并感染组186例（7.1%）。研究发现，HBV感染组、HCV感染组以及HBV和HCV合并感染组的肝脏相关死亡风险均升高（标准化死亡率分别为12.2，95%可信区间[CI]为10.7-13.9；16.8，15.4-18.3；32.9，23.1-46.7），药物所致死亡风险也升高（分别为1.4，1.0-2.0；19.3，18.1-20.5；24.7，18.2-33.5）。在HCV感染者中，死于药物相关原因的风险显著高于肝脏相关原因（p=0.012），15-24岁女性的额外风险最高（56.9，39.2-79.9）。
与标准人群相比，所有组的肝脏相关死亡风险均升高，其中HBV和HCV合并感染组的额外风险最高。我们的数据表明，HCV感染者及合并感染者中，年轻人持续使用药物导致的死亡风险高于感染本身，而HBV感染导致死亡的主要原因是肝脏相关疾病。
