Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA.
J Viral Hepat. 2021 Jun;28(6):934-941. doi: 10.1111/jvh.13498. Epub 2021 Mar 28.
Hepatocellular carcinoma (HCC) is often caused by hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. To investigate the completeness of death certificates for recording viral hepatitis in HCC death, we compared the proportion of HCC deaths with hepatitis virus infection reported on death certificates to that reported as claims in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database among individuals ≥66 years of age. For 2001-2015, we tabulated proportions of HCC deaths with HBV or HCV infection in each database overall, and by demographic factors. To correct for under ascertainment of viral hepatitis-associated HCC on death certificates, we multiplied by the reciprocal ratio of death certificates to SEER-Medicare. Among HCC decedents, HBV infection was reported on 3.6% of death certificates and 17.2% of Medicare claims. For HCV, corresponding proportions were 14.9% and 26.9%. The ratio of HBV-attributable HCC deaths in death certificates to SEER-Medicare remained ~0.21 over time. The ratio of HCV-attributable HCC deaths decreased 22.1% per year, from 0.70 in 2001 to 0.37 in 2003, and increased 4.1% per year, from 0.47 in 2004 to 0.66 in 2015. Following correction, the 2015 mortality rate from death certificate data increased from 0.2 to 0.9 per 100,000 for HBV-attributable HCC and from 2.3 to 3.5 per 100,000 for HCV-attributable HCC. In conclusion, among older Americans dying from HCC, death certificates captured 21% of HBV and 55% of HCV infections compared to Medicare claims. Our results suggest that death certificates provide incomplete data for viral hepatitis-associated HCC surveillance.
肝细胞癌 (HCC) 通常由乙型肝炎病毒 (HBV) 或丙型肝炎病毒 (HCV) 感染引起。为了研究死亡证明记录 HCC 患者病毒性肝炎的完整性，我们比较了≥66 岁人群中，死亡证明报告的 HCC 死亡病例与医疗保险索赔数据库中报告的病毒性肝炎感染病例的比例。在 2001 年至 2015 年期间，我们分别列出了每个数据库中 HBV 或 HCV 感染的 HCC 死亡病例的比例，以及按人口统计学因素进行分类的比例。为了纠正死亡证明中病毒性肝炎相关 HCC 的确定不足，我们将其乘以死亡证明与 SEER-医疗保险的倒数比值。在 HCC 死亡病例中，HBV 感染在死亡证明上的报告率为 3.6%，而在医疗保险索赔中的报告率为 17.2%。对于 HCV，相应的比例分别为 14.9%和 26.9%。随着时间的推移，死亡证明上归因于 HBV 的 HCC 死亡人数与 SEER-医疗保险的比值保持在 0.21 左右。归因于 HCV 的 HCC 死亡人数每年减少 22.1%，从 2001 年的 0.70 降至 2003 年的 0.37，然后每年增加 4.1%，从 2004 年的 0.47 增至 2015 年的 0.66。校正后，2015 年从死亡证明数据得出的归因于 HBV 的 HCC 死亡率从 0.2/100,000 增加到 0.9/100,000，归因于 HCV 的 HCC 死亡率从 2.3/100,000 增加到 3.5/100,000。总之，在美国，与医疗保险索赔相比，死亡证明记录了 21%的 HBV 和 55%的 HCV 感染，这些感染导致了老年 HCC 患者的死亡。我们的研究结果表明，死亡证明提供了关于病毒性肝炎相关 HCC 监测的不完整数据。
