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Observational Study
. 2018 Feb;38(2):239-247.
doi: 10.1111/liv.13501. Epub 2017 Jul 21.

Changing trends in complications of chronic hepatitis C

Mei Lu  1 , Jia Li  1 , Loralee B Rupp  2 , Yueren Zhou  1 , Scott D Holmberg  3 , Anne C Moorman  3 , Philip R Spradling  3 , Eyasu H Teshale  3 , Joseph A Boscarino  4 , Yihe G Daida  5 , Mark A Schmidt  6 , Sheri Trudeau  1 , Stuart C Gordon  7
Affiliations
Observational Study

Changing trends in complications of chronic hepatitis C

Mei Lu et al. Liver Int. 2018 Feb.

Abstract

Background & aims: Chronic hepatitis C virus (HCV)-related complications have increased over the past decade.

Methods: We used join-point regression modelling to investigate trends in these complications from 2006 to 2015, and the impact of demographics on these trends. Using data from the Chronic Hepatitis Cohort Study (CHeCS), we identified points at which the trend significantly changed, and estimated the annual percent change (APC) in rates of cirrhosis, decompensated cirrhosis and all-cause mortality, adjusted by race, sex and age.

Results: Among 11,167 adults with chronic HCV infection, prevalence of cirrhosis increased from 20.8% to 27.6% from 2006 to 2015, with adjusted annual percentage change (aAPC) of 1.2 (p <. 01). Although incidence of all-cause mortality increased from 1.8% in 2006 to 2.9% in 2015, a join-point was identified at 2010, with aAPCs of 9.6 before (2006 < 2010; p < .01) and -5.2 after (2010 ≤ 2015; p < .01), indicating a decrease in mortality from 2010 and onward. Likewise, overall prevalence of decompensated cirrhosis increased from 9.3% in 2006 to 10.4% in 2015, but this increase was confined to patients 60 or older (aAPC = 1.5; p = .023). Asian American and Black/African American patients demonstrated significantly higher rates of cirrhosis than White patients, while older patients and men demonstrated higher rates of cirrhosis and mortality.

Conclusions: Although cirrhosis and mortality among HCV-infected patients in the US have increased over the past decade, all-cause mortality has decreased in recent years.

Keywords: African Americans; Asian Americans; cirrhosis; decompensated cirrhosis.

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Conflict of interest statement

Conflict of interest

Stuart C. Gordon receives grant/research support from AbbVie Pharmaceuticals, Bristol-Myers Squibb, Gilead Pharmaceuticals, GlaxoSmithKline, Intercept Pharmaceuticals, Merck, and Vertex Pharmaceuticals. He is also ad hoc advisor for AbbVie, CVS Caremark, Gilead Sciences, Intercept and Merck; Mei Lu, Jia Li, Lora Rupp, Yueren Zhou, Sheri Trudeau, Yihe G. Daida, Mark A. Schmidt, Joseph A. Boscarino receive grant/research support from Gilead and Intercept Pharmaceuticals.

The other authors have no potential conflicts of interest.

Figures

Figure 1
Figure 1
Prevalence of cirrhosis and decompensated cirrhosis, and incidence of all-cause mortality in CHeCS HCV patients from 2006–2015 (join-points for all-cause mortality in 2010).
Figure 2
Figure 2
Prevalence of cirrhosis by race, sex, and age in CHeCS HCV patients from 2006–2015. No join-points and only one segment were identified. Line segments illustrate the adjusted annual percent change (aAPC).
Figure 3
Figure 3
Prevalence of decompensated cirrhosis by race, sex, and age in CHeCS HCV patients from 2006–2015. No join-points and only one segment were identified. Line segments illustrate the adjusted annual percent change (aAPC).
Figure 4
Figure 4
Incidence of all-cause mortality by sex and age in CHeCS HCV patients from 2006–2015. One join-point (2010) and two segments were identified. Line segments illustrate the adjusted annual percent change (aAPC).
See this image and copyright information in PMC

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