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Observational Study
, 23 (10), 1866-1871

Mortality Associated With Hepatitis C and Hepatitis B Virus Infection: A Nationwide Study on Multiple Causes of Death Data

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Observational Study

Mortality Associated With Hepatitis C and Hepatitis B Virus Infection: A Nationwide Study on Multiple Causes of Death Data

Ugo Fedeli et al. World J Gastroenterol.

Abstract

Aim: To analyze mortality associated with hepatitis C virus (HCV) and hepatitis B virus (HBV) infection in Italy.

Methods: Death certificates mentioning either HBV or HCV infection were retrieved from the Italian National Cause of Death Register for the years 2011-2013. Mortality rates and proportional mortality (percentage of deaths with mention of HCV/HBV among all registered deaths) were computed by gender and age class. The geographical variability in HCV-related mortality rates was investigated by directly age-standardized rates (European standard population). Proportional mortality for HCV and HBV among subjects aged 20-59 years was assessed in the native population and in different immigrant groups.

Results: HCV infection was mentioned in 1.6% (n = 27730) and HBV infection in 0.2% (n = 3838) of all deaths among subjects aged ≥ 20 years. Mortality rates associated with HCV infection increased exponentially with age in both genders, with a male to female ratio close to unity among the elderly; a further peak was observed in the 50-54 year age group especially among male subjects. HCV-related mortality rates were higher in Southern Italy among elderly people (45/100000 in subjects aged 60-79 and 125/100000 in subjects aged ≥ 80 years), and in North-Western Italy among middle-aged subjects (9/100000 in the 40-59 year age group). Proportional mortality was higher among Italian citizens and North African immigrants for HCV, and among Sub-Saharan African and Asian immigrants for HBV.

Conclusion: Population ageing, immigration, and new therapeutic approaches are shaping the epidemiology of virus-related chronic liver disease. In spite of limits due to the incomplete reporting and misclassification of the etiology of liver disease, mortality data represent an additional source of information for surveillance.

Keywords: Epidemiology; Hepatitis B virus; Hepatitis C virus; Immigrants; Mortality.

Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Mortality associated with hepatitis C virus and hepatitis B virus infection: Age and gender-specific mortality rates, Italy 2011-2013. HBV: Hepatitis B virus; HCV: Hepatitis C virus.
Figure 2
Figure 2
Mortality associated with hepatitis C virus and hepatitis B virus infection: Age and gender-specific proportional mortality, Italy 2011-2013. HBV: Hepatitis B virus; HCV: Hepatitis C virus.
Figure 3
Figure 3
Distribution of the underlying cause of death among decedents with mention of hepatitis C or hepatitis B infection, by age class, Italy, 2011-2013.
Figure 4
Figure 4
Mortality associated with hepatitis C virus and hepatitis B virus infection by country of citizenship: Proportional mortality among decedents aged 20-59 years, Italy 2011-2013. HBV: Hepatitis B virus; HCV: Hepatitis C virus.

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