Lotto Marta, Ramier Clémence, Carrat Fabrice, Périères Lauren, Delaroque-Astagneau Elisabeth, Nicol Jérôme, Marcellin Fabienne, Zoulim Fabien, Di Beo Vincent, Bertheau Mathilde, Pol Stanislas, Protopopescu Camelia, Bourlière Marc, Carrieri Patrizia
Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France.
Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France.
BMC Glob Public Health. 2025 Jul 1;3(1):58. doi: 10.1186/s44263-025-00173-7.
Migrants in Europe are disproportionately affected by hepatitis B virus (HBV) infection, especially those coming from endemic countries. We aimed to determine whether migrant status was associated with all-cause mortality risk in people living with chronic HBV infection integrated into a hospital-based care pathway in France.
We analysed clinical and socio-behavioural data collected over 8 years of follow-up among patients with chronic HBV infection enrolled in the French prospective multicentre cohort ANRS CO22 HEPATHER. Migrant status was tested as a binary variable (non-migrants versus migrants) and according to three categories (low, moderate, and high) of HBV endemicity in the migrants' region of birth. The association between migrant status and all-cause mortality risk was assessed using a multivariable Cox proportional hazards model. A competing risks analysis was conducted for liver-related and non-liver-related mortality.
Of the 5597 study participants, accounting for 33,222.8 person-years (PY), 68.1% were migrants, mainly from Sub-Saharan Africa and Asia. During follow-up, 247 patients died and the all-cause mortality rate [95% confidence interval (CI)] was 7.4 [6.6-8.4]/1000 PY. Migrants had a lower mortality rate than non-migrants: 4.5 [3.7-5.5]/1000 PY versus 13.5 [11.4-15.8]/1000 PY (p < 0.001), irrespective of migrants' region of birth and time since arrival in France. After adjustment for sex, age, living in poverty, alcohol use, tobacco smoking, diabetes, and HBV disease phase, the all-cause mortality risk was still lower in migrants than in non-migrants (adjusted hazard ratio [95% CI] 0.58 [0.43-0.78], p < 0.001). All three migrant HBV endemicity categories had a lower risk of all-cause and non-liver-related mortality than non-migrants. By contrast, these differences were not significant for liver-related mortality.
A lower all-cause, liver-related and non-liver-related mortality risk was found among migrants with chronic HBV infection in France compared to non-migrants. However, after multivariable adjustment, the liver-related mortality risk was similar between migrants and non-migrants, indicating that mortality advantage for migrants is explained by the protective adjustment factors, such as younger age, less advanced liver disease and fewer unhealthy behaviours. In contrast, these factors did not fully explain the observed mortality advantage for both non-liver-related and all-cause mortality.
ClinicalTrials.gov registry number: NCT01953458.
欧洲的移民受乙型肝炎病毒（HBV）感染的影响尤为严重，特别是那些来自乙肝流行国家的移民。我们旨在确定在法国纳入医院护理路径的慢性HBV感染患者中，移民身份是否与全因死亡风险相关。
我们分析了法国前瞻性多中心队列ANRS CO22 HEPATHER中慢性HBV感染患者8年随访期间收集的临床和社会行为数据。移民身份作为一个二元变量（非移民与移民）进行测试，并根据移民出生地区的乙肝流行程度分为三类（低、中、高）。使用多变量Cox比例风险模型评估移民身份与全因死亡风险之间的关联。对肝脏相关和非肝脏相关死亡进行了竞争风险分析。
在5597名研究参与者中，共33222.8人年（PY），68.1%为移民，主要来自撒哈拉以南非洲和亚洲。随访期间，247名患者死亡，全因死亡率[95%置信区间（CI）]为7.4[6.6 - 8.4]/1000 PY。移民的死亡率低于非移民：4.5[3.7 - 5.5]/1000 PY对13.5[11.4 - 15.8]/1000 PY（p < 0.001），无论移民的出生地区和抵达法国后的时间如何。在对性别、年龄、生活贫困、饮酒、吸烟、糖尿病和HBV疾病阶段进行调整后，移民的全因死亡风险仍低于非移民（调整后风险比[95% CI] 0.58[0.43 - 0.78]，p < 0.001）。所有三个移民乙肝流行程度类别在全因和非肝脏相关死亡方面的风险均低于非移民。相比之下，这些差异在肝脏相关死亡方面并不显著。
在法国，慢性HBV感染的移民中全因、肝脏相关和非肝脏相关死亡风险低于非移民。然而，经过多变量调整后，移民和非移民之间的肝脏相关死亡风险相似，这表明移民的死亡优势是由保护性调整因素解释的，如年龄较小、肝病进展较轻和不健康行为较少。相比之下，这些因素并不能完全解释观察到的非肝脏相关和全因死亡的死亡率优势。
ClinicalTrials.gov注册号：NCT01953458。
