Impact of hepatitis B on mortality and specific causes of death in adults with and without HIV co-infection in NYC, 2000-2011

Abstract

High rates of immigration from endemic countries contribute to the high chronic hepatitis B (HBV) prevalence in New York City (NYC) compared to the United States overall, i.e. about 1 million individuals. We describe the impact of HBV infection on mortality and specific causes of death in NYC. We matched surveillance and vital statistics mortality data collected from 2000 to 2011 by the New York City Department of Health and Mental Hygiene (DOHMH) and analysed demographics and premature deaths (i.e. whether death occurred at <65 years) in persons with and without chronic HBV or HIV infection (excluding those with hepatitis C). From 2000 to 2011, a total of 588 346 adults died in NYC. Of all decedents, 568 753 (97%) had no report of HIV or HBV, and 4346 (0·7%) had an HBV report. Of HBV-infected decedents, 1074 (25%) were HIV co-infected. Fifty-five percent of HBV mono-infected and 95% of HBV/HIV co-infected decedents died prematurely. HBV disproportionately impacts two subgroups: Chinese immigrants and HIV-infected individuals. These two subgroups are geographically clustered in different neighbourhoods of NYC. Tailoring prevention and treatment messages to each group is necessary to reduce the overall burden of HBV in NYC.

Keywords: HIV/AIDS; Hepatitis B; mortality; surveillance.

Fig. 1.

Proportion of deaths that were not premature, premature (50–64 years) or very premature (<50 years) in New York City, stratified by report of HBV, 2000–2011. *Statistical significance (P < 0·05) when compared to decedents with neither infection.

Fig. 2.

(a) Average age-standardized mortality rate in HBV mono-infected persons/100 000 from 2000 to 2011, (b) percentage Chinese-born in 2010, (c) average age-standardized mortality rate in HBV/HIV co-infected persons per 100 000 from 2000–2011, and (d) poverty category per modified ZCTA in 2010, New York City. * Locator Map [Department of Epidemiology Services, New York City Department of Health. NYC Borough Map (https://www1.nyc.gov/assets/doh/downloads/pdf/epi/NYC_Borough_Map.pdf)].