Mortality among Patients with Cleared Hepatitis C Virus Infection Compared to the General Population: A Danish Nationwide Cohort Study

BACKGROUND: The increased mortality in HCV-infected individuals partly stems from viral damage to the liver and partly from risk-taking behaviours. We examined mortality in patients who cleared their HCV-infection, comparing it to that of the general population. We also addressed the question whether prognosis differed according to age, substance abuse (alcohol abuse and injection drug use) and comorbidity. METHODOLOGY/PRINCIPAL FINDINGS: Patients with cleared HCV-infection were categorized into one of 8 groups according to age (20-39 years or 40-69 years) and patient characteristics (no substance abuse/no comorbidity; substance abuse/no comorbidity; no substance abuse/comorbidity; and substance abuse/comorbidity). For each patient, 4 age- and gender-matched individuals without substance abuse or comorbidity were selected from the general population, comprising a total of 8 comparison cohorts. We analyzed 10-year survival and used stratified Cox Regression analysis to compute mortality rate ratios (MRRs), comparing mortality between the 8 patient groups and the comparison cohorts, adjusting for personal income. Among patients without substance abuse or comorbidity, those aged 40-69 years had the same mortality as the comparison cohort (10-year survival: 95% (95% confidence interval [CI]: 93%-97%), MRR: 1.3 (95% CI: 0.8-2.3)), whereas those aged 20-39 years had higher mortality than the comparison cohort (10-year survival: 93% versus 99%, MRR: 5.7 (95% CI: 2.3-14.0). For both age categories, substance abuse and comorbidity decreased survival and increased MRRs. Patients aged 40-69 years with substance abuse and comorbidity suffered from substantial mortality (MRR: 12.5 (95% CI: 5.1-30.6)). CONCLUSIONS: Mortality in patients aged 40-69 years with cleared HCV-infection is comparable to individuals without HCV, provided they have no substance abuse or comorbidity. Any substance abuse and/or comorbidity not captured in the registries used for our study could explain the increased mortality in patients aged 20-39 years without documented substance abuse or comorbidity

Hepatitis C prevalence in Denmark -an estimate based on multiple national registers

Background: A national survey for chronic hepatitis C has not been performed in Denmark and the prevalence is unknown. Our aim was to estimate the prevalence of chronic hepatitis C from public registers and the proportion of these patients who received specialized healthcare. Methods: Patients with a diagnosis of chronic hepatitis C were identified from four national registers: a laboratory register, the Hospital Discharge Register, a clinical database of chronic viral hepatitis and the Register of Communicable Diseases. The total population diagnosed with hepatitis C was estimated by capture-recapture analysis. The population with undiagnosed hepatitis C was derived from the national register of drug users by comparing diagnosed and tested persons. Results: A total of 6,935 patients diagnosed with chronic hepatitis C were identified in the four registers and the estimated population diagnosed with the disease was 9,166 persons (95% C.I. interval 8,973 – 9,877), corresponding to 0.21% (95% CI 0.21%-0.23%) of the Danish population over 15years of age. The prevalence was highest among persons 40–49years old (0.39%) and males (0.28%). It was estimated that 40% of the diagnosed patients lived in the capital region, and 33.5% had attended specialised healthcare. It was estimated that 46% of hepatitis C patients had not been diagnosed and the total population with chronic hepatitis C in Denmark was 16,888 (95% C.I. 16,474-18,287), corresponding to 0.38% (95% CI 0.37-0.42) of the population over 15years of age. Conclusions: The estimated prevalence of chronic hepatitis C in Denmark was 0.38%. Less than half of the patients with chronic hepatitis C in Denmark have been identified and among these patients, one in three has attended specialised care

HCV-related burden of disease in Europe: a systematic assessment of incidence, prevalence, morbidity, and mortality

Background Hepatitis C virus (HCV) is a leading cause of chronic liver disease, end-stage cirrhosis, and liver cancer, but little is known about the burden of disease caused by the virus. We summarised burden of disease data presently available for Europe, compared the data to current expert estimates, and identified areas in which better data are needed. Methods Literature and international health databases were systematically searched for HCV-specific burden of disease data, including incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and liver transplantation. Data were collected for the WHO European region with emphasis on 22 countries. If HCV-specific data were unavailable, these were calculated via HCV-attributable fractions. Results HCV-specific burden of disease data for Europe are scarce. Incidence data provided by national surveillance are not fully comparable and need to be standardised. HCV prevalence data are often inconclusive. According to available data, an estimated 7.3–8.8 million people (1.1–1.3%) are infected in our 22 focus countries. HCV-specific mortality, DALY, and transplantation data are unavailable. Estimations via HCV-attributable fractions indicate that HCV caused more than 86000 deaths and 1.2 million DALYs in the WHO European region in 2002. Most of the DALYs (95%) were accumulated by patients in preventable disease stages. About one-quarter of the liver transplants performed in 25 European countries in 2004 were attributable to HCV. Conclusion Our results indicate that hepatitis C is a major health problem and highlight the importance of timely antiviral treatment. However, data on the burden of disease of hepatitis C in Europe are scarce, outdated or inconclusive, which indicates that hepatitis C is still a neglected disease in many countries. What is needed are public awareness, co-ordinated action plans, and better data. European physicians should be aware that many infections are still undetected, provide timely testing and antiviral treatment, and avoid iatrogenic transmission

Neurodevelopment of Infants in a Mercury Contaminated Crea in Zimbabwe

In Kadoma in Zimbabwe small-scale gold mining is widespread. Mothers and their infants are exposed in the mining communities to the toxic inorganic mercury vapors from processing the ore using elemental mercury. Methyl-mercury is a well known neurotoxin and endangers the regular development of children. This study examined the influence of exposure to elemental mercury for breast fed infants in Kadoma. 121 mother-child pairs were selected, 40 from a non-exposed control area, 81 from the exposed area in Kadoma. Urine, hair and breast milk was analyzed for total mercury. Mainly urine and breast milk levels were significantly higher for the exposed infants. The infants were clinically examined, and their developmental status assessed. In relation to the exposure markers in urine and breast milk several developmental parameters showed statistically significant negative results, such as the capability of infants to sit, crawl or stand at a certain age. These analyzes indicate that a higher body burden with elemental mercury decreases the speed of a regular development of infants

Neurodevelopment of Infants in a Mercury Contaminated Crea in Zimbabwe

In Kadoma in Zimbabwe small-scale gold mining is widespread. Mothers and their infants are exposed in the mining communities to the toxic inorganic mercury vapors from processing the ore using elemental mercury. Methyl-mercury is a well known neurotoxin and endangers the regular development of children. This study examined the influence of exposure to elemental mercury for breast fed infants in Kadoma. 121 mother-child pairs were selected, 40 from a non-exposed control area, 81 from the exposed area in Kadoma. Urine, hair and breast milk was analyzed for total mercury. Mainly urine and breast milk levels were significantly higher for the exposed infants. The infants were clinically examined, and their developmental status assessed. In relation to the exposure markers in urine and breast milk several developmental parameters showed statistically significant negative results, such as the capability of infants to sit, crawl or stand at a certain age. These analyzes indicate that a higher body burden with elemental mercury decreases the speed of a regular development of infants

Quecksilberexposition von Goldbergarbeiterinnen in der Mongolei. Humanes Biomonitoring von 15–45 Jahre alten Frauen

Steckling N, Böse-O'Reilly S, Gradel C, et al. Quecksilberexposition von Goldbergarbeiterinnen in der Mongolei. Humanes Biomonitoring von 15–45 Jahre alten Frauen. Umweltmedizin in Forschung und Praxis. 2010;15(5):252