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. 2023 Jun;30(6):520-529.
doi: 10.1111/jvh.13824. Epub 2023 Mar 10.

Liver-related mortality among people with hepatitis B and C: Evaluation of definitions based on linked healthcare administrative datasets

Syed Hassan Bin Usman Shah  1 , Maryam Alavi  1 , Behzad Hajarizadeh  1 , Gail Matthews  1 , Heather Valerio  1 , Gregory J Dore  1
Affiliations

Liver-related mortality among people with hepatitis B and C: Evaluation of definitions based on linked healthcare administrative datasets

Syed Hassan Bin Usman Shah et al. J Viral Hepat. 2023 Jun.

Abstract

Routinely collected and linked healthcare administrative datasets could be used to monitor mortality among people with hepatitis B (HBV) and C (HCV). This study aimed to evaluate the concordance in records of liver-related mortality among people with an HBV or HCV notification, between data on hospitalization for end-stage liver disease (ESLD) and death certificates. In New South Wales, Australia, HBV and HCV notifications (1993-2017) were linked to hospital admissions (2001-2018), all-cause mortality (1993-2018) and cause-specific mortality (1993-2016) datasets. Hospitalization for ESLD was defined as a first-time hospital admission due to decompensated cirrhosis (DC) or hepatocellular carcinoma (HCC). Consistency of liver death definition of mortality following hospitalization for ESLD was compared with two death certificate-based definitions of liver deaths coded among primary and secondary cause-specific mortality data, including ESLD-related (deaths due to DC and HCC) and all-liver deaths (ESLD-related and other liver-related causes). Of 63,292 and 107,430 individuals with an HBV and HCV notification, there were 4478 (2.6%) post-ESLD hospitalization deaths, 5572 (3.3%) death certificate liver disease deaths and 2910 (1.7%) death certificate ESLD deaths. Between 2001 and 2016, among HBV post-ESLD hospitalization deaths (n = 891), 63% (562) had death certificate ESLD recorded, and 83% (741) had death certificate liver disease recorded. Between 2001 and 2016, among HCV post-ESLD hospitalization deaths (n = 3587), 58% (2082) had death certificate ESLD recorded, and 87% (3135) had death certificate liver disease recorded. At least one-third of death certificates with DC and HCC as cause of death had no mention of HBV, HCV or viral hepatitis. Our study identified limitations in estimating and tracking HBV and HCV liver disease mortality using death certificate-based data only. The optimum data for this purpose is either ESLD hospitalisations with vital status information or a combination of these with cause-specific death certificate data.

Keywords: cause-specific ESLD-related; cause-specific liver disease-related; hepatitis B; hepatitis C; mortality trends.

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Conflict of interest statement

GJD has received research support from Gilead Sciences, Merck and AbbVie. GM has received research support from Gilead Sciences and AbbVie. Other authors have no commercial relationships that might pose a conflict of interest in connection with this manuscript.

Figures

FIGURE 1
FIGURE 1
Concordance between HBV and HCV post‐ESLD hospitalization deaths and death certificate‐defined ESLD (definition one) and liver disease‐related deaths (definition two) between 2001 and 2016.
FIGURE 2
FIGURE 2
Concordance between DC and HCC component of HBV and HCV post‐ESLD hospitalization deaths and death certificate‐defined ESLD (definition one) and liver disease‐related deaths (definition two) between 2001 and 2016.
FIGURE 3
FIGURE 3
Concordance between HBV and HCV post‐ESLD hospitalization deaths and primary and secondary causes of death between 2001 and 2016. COD, cause of death.
FIGURE 4
FIGURE 4
Trends in death certificate‐defined liver disease, ESLD, DC and HCC deaths with a mention of viral hepatitis among HBV and HCV deaths between 2013 and 2016. *Data prior to 2013 is not shown, given a coding software error that existed pre‐2013 and led to under‐reporting of HBV and HCV deaths.
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