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Objectives To quantify mortality rates for patients successfully treated for hepatitis C in the era of interferon-free, direct acting antivirals and compare these rates with those of the general population.
Design Population based cohort study.
Setting British Columbia, Scotland, and England (England cohort consists of patients with cirrhosis only).
Participants 21 790 people who were successfully treated for hepatitis C in the era of interferon-free antivirals (2014-19). Participants were divided into three liver disease severity groups: people without cirrhosis (pre-cirrhosis), those with compensated cirrhosis, and those with end stage liver disease. Follow-up started 12 weeks after antiviral treatment completion and ended on date of death or 31 December 2019.
Main outcome measures Crude and age-sex standardised mortality rates, and standardised mortality ratio comparing the number of deaths with that of the general population, adjusting for age, sex, and year. Poisson regression was used to identify factors associated with all cause mortality rates.
Results 1572 (7%) participants died during follow-up. The leading causes of death were drug related mortality (n=383, 24%), liver failure (n=286, 18%), and liver cancer (n=250, 16%). Crude all cause mortality rates (deaths per 1000 person years) were 31.4 (95% confidence interval 29.3 to 33.7), 22.7 (20.7 to 25.0), and 39.6 (35.4 to 44.3) for cohorts from British Columbia, Scotland, and England, respectively. All cause mortality was considerably higher than the rate for the general population across all disease severity groups and settings; for example, all cause mortality was three times higher among people without cirrhosis in British Columbia (standardised mortality ratio 2.96, 95% confidence interval 2.71 to 3.23; P<0.001) and more than 10 times higher for patients with end stage liver disease in British Columbia (13.61, 11.94 to 15.49; P<0.001). In regression analyses, older age, recent substance misuse, alcohol misuse, and comorbidities were associated with higher mortality rates.
Conclusion Mortality rates among people successfully treated for hepatitis C in the era of interferon-free, direct acting antivirals are high compared with the general population. Drug and liver related causes of death were the main drivers of excess mortality. These findings highlight the need for continued support and follow-up after successful treatment for hepatitis C to maximise the impact of direct acting antivirals.
The Scottish data used in this study are not publicly available, but can be acquired through successful application to the Public Benefit and Privacy Panel for Health and Social Care (<https://www.informationgovernance.scot.nhs.uk/pbpphsc/home/for-applicants/>). HCVRUK participant data are accessible through application to the HCVRUK Tissue Data Access Committee. Contact Professor William Irving (will.irving@nottingham.ac.uk) for more information. Linked registry data cannot be shared with other research groups. However, linked data can be accessed independently following successful application to NHS digital Data Access Request Service (DARS; for more information, see <https://digital.nhs.uk/services/data-access-request-service-dars>). Data from the British Columbia hepatitis testers cohort are not publicly available. Access to the data might be provided through the British Columbia Centre for Disease Control Institutional Data Access process to researchers who meet the criteria for accessing confidential data. Information on data access is available at BC Centre for Disease Control at the following link: <http://www.bccdc.ca/about/accountability/data-access-requests>
With the current wave of Covid-19 raging in Qatar, extra precautions are the need of the hour, as suggested by Dr Abdullatif al-Khal, chair of the National
Qatar residents should be extra careful over the next three to four weeks as the current wave of Covid-19 is yet to peak, a senior health official has advised.
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