Department of Epidemiology, Regional Health System - Lazio Region, Via S, Costanza 53, 00198, Rome, Italy.
BMC Infect Dis. 2010 Apr 19;10:97. doi: 10.1186/1471-2334-10-97.
Concerns about the hepatitis C virus (HCV) are due to the high risk of chronic liver disease and poor treatment efficacy. Synthesizing evidence from multiple data sources is becoming widely used to estimate HCV-infection prevalence. This paper aims to estimate the prevalence of HCV infection, and the hepatic and extrahepatic sequelae in at-risk groups, using routinely collected data in the Lazio region, Italy.
HCV laboratory surveillance and dialysis, hospital discharge, and drug-user registers were used as information sources to identify at-risk groups and to estimate HCV prevalence and sequelae.Full name and birth date were used as linkage keys for the various health registries. Prevalence was estimated as the percentage of cases within the general population and the at-risk groups, with 95% confidence intervals (95% CI) from 1997 to 2001. The risk of sequelae was estimated through a follow-up of hospital discharges up to December 31, 2004 and calculated as the prevalence ratio in HCV-positive and HCV-negative people, within each at-risk group, with 95% CI.
There were 65,127 HCV-infected people in the study period; the prevalence was 1.24% (95%CI = 1.23%-1.25%) in the whole population, higher in males and older adults. Drug users (35.1%; 95%CI = 34.6-35.7) and dialysis patients (21.1%; 95%CI = 20.2%-22.0%) showed the highest values. Medical procedures with little exposure to blood resulted in higher estimates, ranging between 1.3% and 3.4%, which was not conclusively attributable to the surgical procedures. Cirrhosis, hepatocellular carcinoma and encephalopathy were the most frequent hepatic sequelae; cryoglobulinaemia and non-Hodgkin's lymphoma were the most frequent extrahepatic sequelae.
Synthesising data from multiple routine sources improved estimates of HCV prevalence and sequelae in dialysis patients and drug users, although prevalence validity should be assessed in survey and sequelae need a well-defined longitudinal approach.
人们对丙型肝炎病毒（HCV）的担忧主要是因为慢性肝病风险高且治疗效果不佳。综合来自多个数据源的证据正被广泛用于估计 HCV 感染的流行率。本研究旨在使用意大利拉齐奥地区常规收集的数据来估计 HCV 感染流行率以及高危人群的肝内和肝外后果。
HCV 实验室监测以及透析、住院和药物使用者登记册被用作信息来源，以确定高危人群，并估计 HCV 流行率和后果。全名和出生日期被用作各种卫生登记册的链接键。1997 年至 2001 年，使用各年龄段人群和高危人群中的病例百分比及 95%置信区间（95%CI）来估计流行率。通过对截至 2004 年 12 月 31 日的住院记录进行随访，计算 HCV 阳性和 HCV 阴性个体在各高危人群中的比值比（OR）来估计后果风险，该比值比及其 95%CI 用于估计后果风险。
研究期间共有 65127 例 HCV 感染者；整个人群的流行率为 1.24%（95%CI=1.23%-1.25%），男性和老年人中流行率较高。药物使用者（35.1%；95%CI=34.6%-35.7%）和透析患者（21.1%；95%CI=20.2%-22.0%）的流行率最高。很少接触血液的医疗操作的估计值较高，范围在 1.3%至 3.4%之间，这不能归因于手术操作。肝硬化、肝细胞癌和肝性脑病是最常见的肝脏后果；冷球蛋白血症和非霍奇金淋巴瘤是非肝脏后果中最常见的疾病。
综合多个常规来源的数据提高了对透析患者和药物使用者中 HCV 流行率和后果的估计，但应在调查中评估流行率的有效性，且需要明确的纵向方法来评估后果。
