National Infection Service, Public Health England, London, UK.
The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections, University College London, London, UK.
J Viral Hepat. 2020 Jan;27(1):20-27. doi: 10.1111/jvh.13203. Epub 2019 Oct 3.
Persons with chronic hepatitis C (HCV) infection are at increased risk of end-stage liver disease (ESLD) and hepatocellular carcinoma (HCC). The impact of hepatitis treatment scale-up and elimination strategies on ESLD and HCC incidence is a critical measure of progress towards WHO targets. Data from national laboratory surveillance of HCV diagnoses were linked to inpatient care records in Hospital Episode Statistics (HES). For persons first diagnosed with HCV between 1998 and 2016, we describe the characteristics of those with ESLD and HCC and estimate incidence. Of persons diagnosed with HCV between 1998 and 2016 (104 674), 9.1% (9525) had an admission for ESLD and 2.5% (2610) for HCC. The majority of persons with ESLD and HCC were male (70.7% and 82.7%) and of white ethnicity (89.9% and 82.7%). Crude incidence of ESLD and HCC admission was 10.4 and 3.2 per 1000 person-years, respectively. When compared to 2011-2013, incidence of ESLD and HCC admissions in 2014-2017 were lower (ESLD incidence rate ratio [IRR]: 0.81; 95% Confidence interval [CI]: 0.76-0.86; HCC IRR: 0.90; 95% CI: 0.82-1.00, P = .045). Data linkage showed considerable underreporting of HCV in HES coding for ESLD and HCC (16.0% and 11.3%, respectively). In conclusion, we found a decline in incidence of ESLD and HCC-related inpatient admissions since 2011-2013. Linked analysis is required for the continued monitoring of ESLD and HCC inpatient incidence. However, HES data quality issues around completeness of identifiers contribute to uncertainty in linkage and may limit our ability to robustly monitor progress towards WHO elimination goals.
慢性丙型肝炎（HCV）感染者患终末期肝病（ESLD）和肝细胞癌（HCC）的风险增加。评估扩大肝炎治疗和消除策略对 ESLD 和 HCC 发病率的影响，是衡量世卫组织目标进展的重要指标。国家 HCV 诊断实验室监测数据与医院入院统计数据（HES）中的住院记录相关联。对于 1998 年至 2016 年间首次被诊断为 HCV 的患者，我们描述了 ESLD 和 HCC 患者的特征，并对发病率进行了估计。在 1998 年至 2016 年间被诊断为 HCV 的患者中（104674 人），有 9.1%（9525 人）因 ESLD 入院，2.5%（2610 人）因 HCC 入院。大多数 ESLD 和 HCC 患者为男性（70.7%和 82.7%）和白人（89.9%和 82.7%）。ESLD 和 HCC 入院的粗发病率分别为每 1000 人年 10.4 例和 3.2 例。与 2011-2013 年相比，2014-2017 年 ESLD 和 HCC 入院率较低（ESLD 发病率比[IRR]：0.81；95%置信区间[CI]：0.76-0.86；HCC IRR：0.90；95%CI：0.82-1.00，P=0.045）。数据链接显示，HES 编码的 ESLD 和 HCC 中 HCV 报告率明显较低（分别为 16.0%和 11.3%）。总之，自 2011-2013 年以来，我们发现 ESLD 和 HCC 相关住院入院率下降。需要进行链接分析，以持续监测 ESLD 和 HCC 住院发病率。然而，HES 数据在标识符完整性方面存在质量问题，导致链接存在不确定性，可能限制了我们对世卫组织消除目标进展情况进行稳健监测的能力。
