Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA.
Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA.
Liver Int. 2018 Feb;38(2):239-247. doi: 10.1111/liv.13501. Epub 2017 Jul 21.
BACKGROUND & AIMS: Chronic hepatitis C virus (HCV)-related complications have increased over the past decade.
We used join-point regression modelling to investigate trends in these complications from 2006 to 2015, and the impact of demographics on these trends. Using data from the Chronic Hepatitis Cohort Study (CHeCS), we identified points at which the trend significantly changed, and estimated the annual percent change (APC) in rates of cirrhosis, decompensated cirrhosis and all-cause mortality, adjusted by race, sex and age.
Among 11,167 adults with chronic HCV infection, prevalence of cirrhosis increased from 20.8% to 27.6% from 2006 to 2015, with adjusted annual percentage change (aAPC) of 1.2 (p <. 01). Although incidence of all-cause mortality increased from 1.8% in 2006 to 2.9% in 2015, a join-point was identified at 2010, with aAPCs of 9.6 before (2006 < 2010; p < .01) and -5.2 after (2010 ≤ 2015; p < .01), indicating a decrease in mortality from 2010 and onward. Likewise, overall prevalence of decompensated cirrhosis increased from 9.3% in 2006 to 10.4% in 2015, but this increase was confined to patients 60 or older (aAPC = 1.5; p = .023). Asian American and Black/African American patients demonstrated significantly higher rates of cirrhosis than White patients, while older patients and men demonstrated higher rates of cirrhosis and mortality.
Although cirrhosis and mortality among HCV-infected patients in the US have increased over the past decade, all-cause mortality has decreased in recent years.
在过去的十年中，慢性丙型肝炎病毒（HCV）相关并发症有所增加。
我们使用连接点回归模型来研究 2006 年至 2015 年这些并发症的趋势，以及人口统计学因素对这些趋势的影响。利用慢性丙型肝炎队列研究（CHeCS）的数据，我们确定了趋势发生显著变化的时间点，并估计了肝硬化、失代偿性肝硬化和全因死亡率的调整后年变化率（APC），调整因素包括种族、性别和年龄。
在 11167 名患有慢性 HCV 感染的成年人中，肝硬化的患病率从 2006 年的 20.8%增加到 2015 年的 27.6%，调整后的年百分比变化率（aAPC）为 1.2（p<.01）。尽管全因死亡率的发生率从 2006 年的 1.8%增加到 2015 年的 2.9%，但在 2010 年发现了一个连接点，2010 年之前的 aAPC 为 9.6（2006<2010；p<.01），2010 年之后为-5.2（2010≤2015；p<.01），这表明自 2010 年以来死亡率有所下降。同样，失代偿性肝硬化的总体患病率从 2006 年的 9.3%增加到 2015 年的 10.4%，但这种增加仅限于 60 岁或以上的患者（aAPC=1.5；p=.023）。亚裔美国人及非裔美国人/非洲裔美国人患者的肝硬化发生率明显高于白人患者，而老年患者和男性患者的肝硬化和死亡率较高。
尽管过去十年中美国 HCV 感染患者的肝硬化和死亡率有所增加，但近年来全因死亡率有所下降。
