National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney, NSW, Australia.
J Viral Hepat. 2011 Jan;18(1):32-41. doi: 10.1111/j.1365-2893.2010.01279.x.
The aim of this study was to measure the impact of hepatitis C virus (HCV) infection on mortality in a cohort of inner city residents. The Community Health and Safety Evaluation is a community-based study of inner city residents followed retrospectively and prospectively through linkages with provincial virology and mortality databases. We identified participants having received HCV antibody testing, evaluated cause-specific mortality rates and factors associated with all-cause and liver-related mortality using Cox Proportional Hazards models. Overall, 2332 participants received HCV antibody testing (recent non-injection drug use - 81%). The prevalence of HCV and HIV was 64% (1495 of 2332) and 21% (485 of 2332), respectively. Between January 2003 and December 2007, there were 180 deaths (192 per 10.000 person-years; 95% CI: 165, 222), with 21% HIV-related, 20% drug-related and 7% liver-related. Mortality was associated with age >50 [adjusted hazard ratio (AHR) 2.80 vs < 40 years (referent group); 95% CI 1.93, 4.07, P < 0.001] and HIV infection (AHR 3.81; 95% CI 2.72, 5.34, P < 0.001), but not positive HCV antibody status (AHR 1.19; 95% CI 0.83, 1.72, P = 0.35). Liver-related mortality was associated with age >50 [AHR 18.49 vs < 40 years (referent group); 95% CI 2.27, 150.41, P < 0.001] and positive HCV antibody status (AHR 7.69; 95% CI 0.99, 59.98, P = 0.052). This study demonstrates a high rate of mortality in this population, particularly those with HIV. HCV-infected inner city residents >50 years of age were at significant risk of liver-related mortality. Continued surveillance of this population infected with HCV in the 1970s and 1980s is important.
本研究旨在衡量丙型肝炎病毒 (HCV) 感染对城市内居民队列死亡率的影响。社区健康和安全评估是一项对城市内居民进行的基于社区的研究，通过与省级病毒学和死亡率数据库的链接进行回顾性和前瞻性随访。我们确定了接受 HCV 抗体检测的参与者，使用 Cox 比例风险模型评估了特定原因死亡率以及与全因和肝脏相关死亡率相关的因素。总体而言，2332 名参与者接受了 HCV 抗体检测（近期非注射药物使用者占 81%）。HCV 和 HIV 的患病率分别为 64%（2332 人中的 1495 人）和 21%（2332 人中的 485 人）。2003 年 1 月至 2007 年 12 月期间，有 180 人死亡（每 10000 人年 192 人；95%CI：165, 222），其中 21%与 HIV 相关，20%与药物相关，7%与肝脏相关。死亡率与年龄 >50 岁有关[调整后的危险比（AHR）2.80 与 <40 岁（参照组）；95%CI 1.93, 4.07，P <0.001]和 HIV 感染（AHR 3.81；95%CI 2.72, 5.34，P <0.001），但与 HCV 抗体阳性状态无关（AHR 1.19；95%CI 0.83, 1.72，P = 0.35）。肝脏相关死亡率与年龄 >50 岁有关[AHR 18.49 与 <40 岁（参照组）；95%CI 2.27, 150.41，P <0.001]和 HCV 抗体阳性状态（AHR 7.69；95%CI 0.99, 59.98，P = 0.052）。本研究表明，该人群的死亡率很高，尤其是 HIV 感染者。70 年代和 80 年代感染 HCV 的城市内居民年龄 >50 岁，肝脏相关死亡率的风险显著增加。继续监测这一人群的 HCV 感染情况非常重要。
