澳大利亚新南威尔士州病毒性肝炎肝脏相关发病率和死亡率的趋势。
Trends in viral hepatitis liver-related morbidity and mortality in New South Wales, Australia.
作者信息
Tillakeratne Shane, Pearson Sallie-Anne, Alavi Maryam, Hajarizadeh Behzad, Martinello Marianne, Law Matthew, George Jacob, Amin Janaki, Matthews Gail, Grebely Jason, Dore Gregory J, Valerio Heather
机构信息
The Kirby Institute, UNSW Sydney, Australia.
School of Population Health, UNSW Sydney, Australia.
出版信息
Lancet Reg Health West Pac. 2024 Aug 31;51:101185. doi: 10.1016/j.lanwpc.2024.101185. eCollection 2024 Oct.
BACKGROUND
Monitoring hepatitis B virus (HBV) and hepatitis C virus (HCV) liver-related morbidity and mortality is key to evaluate progress towards elimination targets.
METHODS
HBV and HCV notifications in NSW, Australia (1995-2022) were linked to hospital and mortality records. Temporal trends in decompensated cirrhosis (DC), hepatocellular carcinoma (HCC), and mortality were evaluated among people notified for HBV and HCV. Segmented Poisson regression models were used to assess the impact of the viral hepatitis elimination era (1 January 2015-31 December 2022) on advanced liver disease and mortality.
FINDINGS
During 1995-2022, there were 64,865 people with an HBV notification and 112,277 people with an HCV notification in NSW. Between 2002 and 2022, there were significant reductions in age-adjusted HBV- and HCV-related DC, HCC, and liver-related mortality. Among those with HBV, age-standardised incidence per 1000 person-years (py) in 2002, 2015, and 2022 was 3.08, 1.47, and 1.16 for DC (p < 0.001); 2.97, 1.45, and 0.75 for HCC (p < 0.001); and 2.84, 1.93, and 1.40 for liver-related mortality (p < 0.001). Among those with HCV, age-standardised incidence per 1000 py in 2002, 2015, and 2022, was 5.53, 4.57, and 2.31 for DC (p < 0.001); 2.22, 2.59, and 1.87 for HCC (p < 0.001); and 3.89, 4.73, and 3.16 for liver-related mortality (p < 0.001). In 2022, absolute liver-related mortality per 100,000 population was 0.95 for HBV and 3.56 for HCV. In adjusted analyses, older age, comorbidity, and a history of alcohol use disorder were associated with increased liver-related mortality among those with HBV and HCV.
INTERPRETATION
This population-level study demonstrated declining risks of DC, HCC, and mortality, with HBV-related declines commencing well before elimination era while HCV-related declines were mostly during elimination era. Population liver mortality indicates elimination target achieved for combined viral hepatitis and HBV, but not HCV.
FUNDING
The Kirby Institute, UNSW Sydney, and New South Wales Ministry of Health, Australia.
背景
监测乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）与肝脏相关的发病率和死亡率是评估消除目标进展情况的关键。
方法
澳大利亚新南威尔士州（1995 - 2022年）的HBV和HCV报告病例与医院及死亡记录相关联。对HBV和HCV报告病例中的失代偿期肝硬化（DC）、肝细胞癌（HCC）及死亡率的时间趋势进行评估。采用分段泊松回归模型评估病毒性肝炎消除时代（2015年1月1日至2022年12月31日）对晚期肝病和死亡率的影响。
研究结果
1995 - 2022年期间，新南威尔士州有64865例HBV报告病例和112277例HCV报告病例。2002年至2022年期间，年龄调整后的HBV和HCV相关的DC、HCC及肝脏相关死亡率显著下降。在HBV感染者中，2002年、2015年和2022年每1000人年（py）的年龄标准化发病率，DC分别为3.08、1.47和1.16（p < 0.001）；HCC分别为2.97、1.45和0.75（p < 0.001）；肝脏相关死亡率分别为2.84、1.93和1.40（p < 0.001）。在HCV感染者中，2002年、2015年和2022年每1000 py的年龄标准化发病率，DC分别为5.53、4.57和2.31（p < 0.001）；HCC分别为2.22、2.59和1.87（p < 0.001）；肝脏相关死亡率分别为3.89、4.73和3.16（p < 0.001）。2022年，每10万人口中与肝脏相关的绝对死亡率，HBV为0.95，HCV为3.56。在调整分析中，年龄较大、合并症及有酒精使用障碍史与HBV和HCV感染者肝脏相关死亡率增加有关。
解读
这项人群水平的研究表明，DC、HCC和死亡率风险下降，与HBV相关的下降在消除时代开始前就已出现，而与HCV相关的下降大多发生在消除时代。人群肝脏死亡率表明，合并病毒性肝炎和HBV已实现消除目标，但HCV未实现。
资助
悉尼新南威尔士大学柯比研究所和澳大利亚新南威尔士州卫生部。
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