School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom.
Health Protection Scotland, Glasgow Caledonian University, Glasgow, United Kingdom.
Hepatology. 2018 Jan;67(1):97-107. doi: 10.1002/hep.29419. Epub 2017 Nov 16.
In resource-rich countries, chronic hepatitis C (CHC) infection is associated with a sizeable excess mortality risk. The extent to which this is due to (1) the biological sequelae of CHC infection versus (2) a high concomitant burden of health risk behaviors (HRBs) is unclear. We used data from the 1999-2010 U.S. National Health and Nutritional Examination Surveys (NHANES), which include detailed information on HRBs and CHC infection status. We calculated the prevalence of the five major HRBs-alcohol use; cigarette smoking, physical inactivity, unhealthy diet, and illicit drug use-according to CHC after adjusting for sociodemographic differences. Mortality status after survey interview was ascertained by linkage to the U.S. National Death Index. To assess the contribution of HRBs to the excess mortality risk, we determined the all-cause mortality rate ratio (MRR) for individuals with CHC relative to individuals without, and then calculated the attenuation in this MRR following adjustment for HRBs. This analysis included 27,468 adult participants of NHANES of which 363 tested positive for CHC. All HRBs were markedly more prevalent among individuals with CHC versus individuals without. CHC was associated with a 2.4-fold higher mortality rate after adjustment for sociodemographic factors (MRR, 2.36; 95% CI, 1.60-3.49). Subsequent adjustment for all five HRBs attenuated this ratio by 50.7% to MRR 1.67 (95% CI, 1.14-2.44). Higher levels of attenuation (69.1%) were observed among individuals aged 45-70 years, who form the target demographic for U.S. birth cohort screening.
At least half the excess mortality risk for individuals with CHC in the United States may be attributed to HRBs rather than CHC. The remedial response to hepatitis C must not neglect action on HRBs if it is to fully resolve the high mortality problem in this population. (Hepatology 2018;67:97-107).
在资源丰富的国家，慢性丙型肝炎（CHC）感染与相当大的超额死亡风险相关。但这种情况是由于（1）CHC 感染的生物学后果，还是（2）同时存在大量健康风险行为（HRB）负担，尚不清楚。我们使用了来自 1999 年至 2010 年美国国家健康和营养检查调查（NHANES）的数据，这些数据包括关于 HRB 和 CHC 感染状况的详细信息。我们根据 CHC 调整了社会人口统计学差异后，计算了五种主要 HRB-饮酒、吸烟、身体活动不足、不健康饮食和非法药物使用的流行率。通过与美国国家死亡指数的链接，确定了调查访谈后的死亡状况。为了评估 HRB 对超额死亡风险的贡献，我们确定了 CHC 个体相对于无 CHC 个体的全因死亡率比（MRR），然后计算了在调整 HRB 后，该 MRR 的衰减程度。这项分析包括了 27468 名 NHANES 的成年参与者，其中 363 名测试呈 CHC 阳性。与无 CHC 个体相比，所有 HRB 在 CHC 个体中明显更为普遍。在调整社会人口统计学因素后，CHC 与死亡率增加 2.4 倍相关（MRR，2.36；95%CI，1.60-3.49）。随后调整所有五个 HRB 将该比值降低 50.7%，降至 MRR 1.67（95%CI，1.14-2.44）。在年龄为 45-70 岁的个体中观察到更高水平的衰减（69.1%），他们是美国出生队列筛查的目标人群。
在美国，CHC 个体的超额死亡风险的至少一半可能归因于 HRB，而不是 CHC。如果要完全解决该人群的高死亡率问题，那么对丙型肝炎的治疗反应绝不能忽视对 HRB 的干预。（Hepatology 2018；67：97-107）。
