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Patients with HCV engage in risky behavior, causing excess mortality

Health risk behaviors, such as alcohol use, cigarette smoking and unhealthy diets, contributed equally toward mortality risk for patients with chronic hepatitis C as the infection itself, according to a recently published study.

“Individuals with [chronic HCV] infection in the U.S. exhibit a considerable excess mortality risk. Yet, about half of this excess may reflect high levels of [health risk behaviors] as opposed to the effects of [chronic HCV] infection itself,” Hamish Innes, MD, from Glasgow Caledonian University, and colleagues wrote. “This study therefore highlights the importance of a public health response to hepatitis C that includes action on [health risk behaviors] as well as access to antiviral therapy.”

The study comprised 27,468 adults who participated in NHANES from 1999 to 2010, including 363 patients with chronic HCV. The participants completed a household interview, mobile examination center assessment and dietary questionnaire.

The health risk behaviors assessed in the researchers’ interviews and surveys included alcohol use, cigarette smoking, physical inactivity, unhealthy diet and illicit drug use. Participants reported illicit drug use anonymously.

At the end of follow-up (mean, 6.2 years), 2,599 patients had died (43 from chronic HCV). The proportion of participants missing data for a given covariate was up to 6%, although the proportion of missing data was much higher for illicit drug use (25.5%) and HIV status (38.8%).

Prevalence of health risk behaviors was significantly higher among patients with chronic HCV. Compared with the rest of the cohort, those with chronic HCV were more likely to have former heavy use of alcohol (39.6% vs. 19.1%; P < .001), have current use of more than two (18.7% vs. 8.3%; P < .001) or more than five drinks per day (6.9% vs. 1.7%; P = .008), currently smoke (63.8% vs. 28.2%; P < .001), and have an unhealthy diet (74.7% vs. 65.8%; P < .001).

Those with chronic HCV were less likely to have former non-injecting drug use (8.3% vs. 16%; P < .001), but otherwise more likely to have former drug use including injection (30.8% vs. 1.3%; P < .001), current non-injecting use (16.2% vs. 4.7%; P < .001) and current injecting use (9.3% vs. 0.1%; P < .001), compared with the rest of the cohort.

The researchers found that the mortality rate ratio for chronic HCV patients compared with the rest of the cohort remained significantly higher after adjusting for sociodemographic factors alone (mortality risk ratio = 2.36; 95% CI, 1.6-3.49), sociodemographic factors and comorbid medical conditions (MRR = 2.35; 95% CI, 1.62-3.41), sociodemographic factors and former health risk behaviors (MRR = 2.27; 95% CI, 1.47-3.52), and sociodemographic factors and current health risk behaviors (MRR = 1.66; 95% CI, 1.19-2.32).

In a subgroup analysis of participants aged 45 to 70 years (n = 10,810), the mortality risk ratio was smaller for the full cohort after the researchers adjusted for sociodemographic factors (MRR = 1.68; 95% CI, 0.89-3.2), while adjustment for current health risk behaviors attenuated the mortality risk ratio by 69.6% and adjustment for combined current and former health risk behaviors attenuated the mortality risk ratio by 69.1%.

“The key finding from this study is that this excess mortality risk attenuated considerably ... following subsequent adjustment for all [health risk behaviors],” the researchers concluded. “Overall this study cautions that — advancements in antiviral therapy aside — a sizeable excess mortality risk is likely to persist for individuals with past/present [chronic HCV] unless more attention is paid to tackling coexisting [health risk behaviors].” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.