Mortality trends among people with hepatitis B and C: A population-based linkage study, 1993-2012

Maryam Alavi*, Jason Grebely, Behzad Hajarizadeh, Janaki Amin, Sarah Larney, Matthew G. Law, Jacob George, Louisa Degenhardt, Gregory J. Dore

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    18 Citations (Scopus)
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    Background: This study evaluated cause-specific mortality trends including liver-related mortality among people with a hepatitis B virus (HBV) and hepatitis C virus (HCV) notification in New South Wales, Australia. Methods: Notifications 1993-2012 were linked to cause-specific mortality records 1993-2013. Results: Among 57,929 and 92,474 people with a HBV and HCV notification, 4.8% and 10.0% died since 1997. In early 2010s, 28% and 33% of HBV and HCV deaths were liver-related, 28% and 17% were cancer-related (excluding liver cancer), and 5% and 15% were drug-related, respectively. During 2002-2012, annual HBV-related liver death numbers were relatively stable (53 to 68), while HCV-related liver death numbers increased considerably (111 to 284). Age-standardised HBV-related liver mortality rates declined from 0.2 to 0.1 per 100 person-years (PY) (P<0.001); however, HCV-related rates remained stable (0.2 to 0.3 per 100 PY, P=0.619). In adjusted analyses, older age was the strongest predictor of liver-related mortality [birth earlier than 1945, HBV adjusted hazard ratio (aHR) 28.1, 95% CI 21.0, 37.5 and; HCV aHR 31.9, 95% CI 26.8, 37.9], followed by history of alcohol-use disorder (HBV aHR 7.0, 95% CI 5.5, 8.8 and; HCV aHR 8.3, 95% CI 7.6, 9.1). Conclusions: Declining HBV-related liver mortality rates and stable burden suggest an impact of improved antiviral therapy efficacy and uptake. In contrast, the impact of interferon-containing HCV treatment programs on liver-related mortality individual-level risk and population-level burden has been limited. These findings also highlight the importance of HBV/HCV public health interventions that incorporate increased antiviral therapy uptake, and action on health risk behaviors.

    Original languageEnglish
    Article number215
    Pages (from-to)1-10
    Number of pages10
    JournalBMC Infectious Diseases
    Issue number1
    Publication statusPublished - 9 May 2018

    Bibliographical note

    Copyright the Author(s) 2018. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.


    • Cause-specific mortality
    • Drug-related mortality
    • HBV
    • HCV
    • Liver-related mortality


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