National Infection Service, Public Health England, London, United Kingdom.
The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London, United Kingdom.
Euro Surveill. 2019 Jul;24(30). doi: 10.2807/1560-7917.ES.2019.24.30.1800695.
BackgroundMonitoring trends in mortality for individuals diagnosed with hepatitis C virus (HCV) infection are important as we expand treatment and move towards World Health Organization elimination targets.AimTo estimate mortality rates for individuals aged ≥ 15 years diagnosed with HCV infection in England 2008-16.MethodsAn observational cohort study whereby death certificate information was linked to the Sentinel Surveillance of Blood Borne Virus Testing in England. Age-sex standardised mortality rates (ASMR) for individuals diagnosed with HCV infection (2008-16) were calculated and compared to the general population.ResultsOf 43,895 individuals with HCV infection, 2,656 (6.3%) died. All-cause ASMRs were 2,834.2 per 100,000 person years (PY), 2.3 times higher than in the general population. In individuals aged 30-69 years, all-cause mortality rates were 1,768.9 per 100,000 PY among individuals with HCV, 4.7 times higher than in the general population. ASMRs had not decreased between 2010 (2,992) and 2016 (2,340; p=0.10), with no change from 2014 (p = 0.058). ASMRs were 441.0 times higher for hepatitis, 34.4 times higher for liver cancer, 8.1 times higher for end stage liver disease and 6.4 times higher for external causes than in the general population.ConclusionsMortality was higher in individuals with diagnosed HCV infection compared to the general population, highlighting health inequalities. There is a need to improve HCV diagnosis, engagement in care and treatment rates. The high mortality from external causes highlights the importance of integrated health and social care strategies and addressing the needs of this vulnerable population.
背景
监测诊断为丙型肝炎病毒 (HCV) 感染的个体的死亡率趋势非常重要，因为我们正在扩大治疗范围，并朝着世界卫生组织消除目标迈进。
目的
评估 2008 年至 2016 年期间在英格兰诊断为 HCV 感染的年龄≥15 岁个体的死亡率。
方法
这是一项观察性队列研究，通过死亡证明信息与英格兰血液传播病毒检测哨点监测进行了关联。计算了诊断为 HCV 感染（2008-16 年）的个体的年龄-性别标准化死亡率 (ASMR)，并与一般人群进行了比较。
结果
在 43895 名 HCV 感染个体中，有 2656 人（6.3%）死亡。所有原因的 ASMR 为每 100000 人年 2834.2 人，是一般人群的 2.3 倍。在 30-69 岁年龄组中，HCV 感染者的所有原因死亡率为每 100000 人年 1768.9 人，是一般人群的 4.7 倍。2010 年（2992）和 2016 年（2340）之间的 ASMR 没有下降（p=0.10），2014 年也没有变化（p=0.058）。HCV 相关死亡率比一般人群高 441.0 倍，肝癌高 34.4 倍，终末期肝病高 8.1 倍，外部原因高 6.4 倍。
结论
与一般人群相比，诊断为 HCV 感染的个体死亡率更高，突出了健康不平等问题。需要提高 HCV 的诊断率，提高参与护理和治疗的比例。由于外部原因导致的高死亡率突出了综合卫生和社会保健策略的重要性，以及满足这一脆弱人群需求的重要性。
