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. 2020 Jul 25;7(8):ofaa308.
doi: 10.1093/ofid/ofaa308. eCollection 2020 Aug.

All-Cause Mortality and Causes of Death in the Swiss Hepatitis C Cohort Study (SCCS)

Maroussia Roelens  1 , Barbara Bertisch  1 , Darius Moradpour  2 , Andreas Cerny  3 , Nasser Semmo  4 , Patrick Schmid  5 , Beat Müllhaupt  6 , Olivier Clerc  7 , David Semela  8 , Christoph Junker  9 , Francesco Negro  10   11 , Olivia Keiser  1 ; Swiss Hepatitis C Cohort Study
Collaborators, Affiliations

All-Cause Mortality and Causes of Death in the Swiss Hepatitis C Cohort Study (SCCS)

Maroussia Roelens et al. Open Forum Infect Dis. .

Abstract

Background: With direct-acting antiviral agents (DAAs), mortality rates and causes of death among persons with hepatitis C virus (HCV) infection may change over time. However, the emergence of such trends may be delayed by the slow progression of chronic hepatitis C. To date, detailed analyses of cause-specific mortality among HCV-infected persons over time remain limited.

Methods: We evaluated changes in causes of death among Swiss Hepatitis C Cohort Study (SCCS) participants from 2008 to 2016. We analyzed risk factors for all-cause and cause-specific mortality, accounting for changes in treatment, fibrosis stage, and use of injectable drugs over time. Mortality ascertainment was completed by linking lost-to-follow-up participants to the Swiss Federal Statistical Office death registry.

Results: We included 4700 SCCS participants, of whom 478 died between 2008 and 2016. The proportion of unknown causes of death decreased substantially after linkage, from 42% to 10%. Leading causes of death were liver failure (crude death rate 4.4/1000 person-years), liver cancer (3.4/1000 person-years), and nonliver cancer (2.8/1000 person-years), with an increasing proportion of cancer-related deaths over time. Cause-specific analysis showed that persons with sustained virologic response were less at risk for liver-related mortality than those never treated or treated unsuccessfully.

Conclusions: Although the expected decrease in mortality is not yet observable, causes of death among HCV-infected persons have evolved over time. With the wider use of DAAs, liver-related mortality is expected to decline in the future. Continued monitoring of cause-specific mortality will remain important to assess the long-term effect of DAAs and design effective interventions.

Keywords: Switzerland; cohort; hepatitis C; mortality; risk factors.

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Figures

Figure 1.
Figure 1.
Flowchart illustrating the linkage between the Swiss Hepatitis C Cohort Study (SCCS) and the death registry of the Swiss Federal Office of Statistics (SFSO).
Figure 2.
Figure 2.
Crude mortality rates over the years for all-cause mortality, liver failure, and liver cancer mortality in the Swiss Hepatitis C Cohort Study.
Figure 3.
Figure 3.
Cumulative incidence of different causes of death since registration in the Swiss Hepatitis C cohort study (causes of death are in the same order in the legend and on the plot).
See this image and copyright information in PMC

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