Trends in viral hepatitis liver-related morbidity and mortality in New South Wales, Australia

IF 7.6 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES The Lancet Regional Health: Western Pacific Pub Date : 2024-08-31 DOI:10.1016/j.lanwpc.2024.101185

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Abstract

Background

Monitoring hepatitis B virus (HBV) and hepatitis C virus (HCV) liver-related morbidity and mortality is key to evaluate progress towards elimination targets.

Methods

HBV and HCV notifications in NSW, Australia (1995–2022) were linked to hospital and mortality records. Temporal trends in decompensated cirrhosis (DC), hepatocellular carcinoma (HCC), and mortality were evaluated among people notified for HBV and HCV. Segmented Poisson regression models were used to assess the impact of the viral hepatitis elimination era (1 January 2015–31 December 2022) on advanced liver disease and mortality.

Findings

During 1995–2022, there were 64,865 people with an HBV notification and 112,277 people with an HCV notification in NSW. Between 2002 and 2022, there were significant reductions in age-adjusted HBV- and HCV-related DC, HCC, and liver-related mortality. Among those with HBV, age-standardised incidence per 1000 person-years (py) in 2002, 2015, and 2022 was 3.08, 1.47, and 1.16 for DC (p < 0.001); 2.97, 1.45, and 0.75 for HCC (p < 0.001); and 2.84, 1.93, and 1.40 for liver-related mortality (p < 0.001). Among those with HCV, age-standardised incidence per 1000 py in 2002, 2015, and 2022, was 5.53, 4.57, and 2.31 for DC (p < 0.001); 2.22, 2.59, and 1.87 for HCC (p < 0.001); and 3.89, 4.73, and 3.16 for liver-related mortality (p < 0.001). In 2022, absolute liver-related mortality per 100,000 population was 0.95 for HBV and 3.56 for HCV. In adjusted analyses, older age, comorbidity, and a history of alcohol use disorder were associated with increased liver-related mortality among those with HBV and HCV.

Interpretation

This population-level study demonstrated declining risks of DC, HCC, and mortality, with HBV-related declines commencing well before elimination era while HCV-related declines were mostly during elimination era. Population liver mortality indicates elimination target achieved for combined viral hepatitis and HBV, but not HCV.

Funding

The Kirby Institute, UNSW Sydney, and New South Wales Ministry of Health, Australia.

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澳大利亚新南威尔士州与病毒性肝炎肝脏相关的发病率和死亡率趋势

背景监测乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）与肝脏相关的发病率和死亡率是评估消除目标进展情况的关键。方法将澳大利亚新南威尔士州（1995-2022 年）的 HBV 和 HCV 感染病例与医院和死亡记录联系起来，评估了失代偿性肝硬化 (DC)、肝细胞癌 (HCC) 和死亡率的时间趋势。研究采用分段泊松回归模型来评估消除病毒性肝炎时代（2015 年 1 月 1 日至 2022 年 12 月 31 日）对晚期肝病和死亡率的影响。研究结果1995 年至 2022 年期间，新南威尔士州有 64,865 人感染了 HBV，112,277 人感染了 HCV。2002 年至 2022 年期间，年龄调整后的 HBV 和 HCV 相关 DC、HCC 和肝脏相关死亡率显著下降。在 HBV 感染者中，2002 年、2015 年和 2022 年每千人年年龄标准化 DC 发病率分别为 3.08、1.47 和 1.16（p < 0.001）；HCC 发病率分别为 2.97、1.45 和 0.75（p < 0.001）；肝脏相关死亡率分别为 2.84、1.93 和 1.40（p < 0.001）。在感染 HCV 的人群中，2002 年、2015 年和 2022 年，每 1000 py 中 DC 的年龄标准化发病率分别为 5.53、4.57 和 2.31（p < 0.001）；HCC 分别为 2.22、2.59 和 1.87（p < 0.001）；肝脏相关死亡率分别为 3.89、4.73 和 3.16（p < 0.001）。2022 年，每 100,000 人中与肝脏相关的绝对死亡率，HBV 为 0.95，HCV 为 3.56。在调整后的分析中，HBV 和 HCV 感染者中，年龄较大、合并症和酗酒史与肝脏相关死亡率的增加有关。这项人群水平的研究表明，DC、HCC 和死亡率的风险在下降，其中 HBV 相关风险的下降早在消除时代之前就开始了，而 HCV 相关风险的下降主要发生在消除时代。人口肝脏死亡率表明，合并病毒性肝炎和 HBV 的消除目标已经实现，但 HCV 尚未实现。

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来源期刊

The Lancet Regional Health: Western Pacific Medicine-Pediatrics, Perinatology and Child Health

CiteScore

8.80

自引率

2.80%

发文量

305

审稿时长

11 weeks

期刊介绍： The Lancet Regional Health – Western Pacific, a gold open access journal, is an integral part of The Lancet's global initiative advocating for healthcare quality and access worldwide. It aims to advance clinical practice and health policy in the Western Pacific region, contributing to enhanced health outcomes. The journal publishes high-quality original research shedding light on clinical practice and health policy in the region. It also includes reviews, commentaries, and opinion pieces covering diverse regional health topics, such as infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, aging health, mental health, the health workforce and systems, and health policy.