High risk of non-alcoholic liver disease mortality in patients with chronic hepatitis C with illicit substance use disorder

Martin Kåberg, Simon B. Larsson, Anna Jerkeman, Anders Nystedt, Ann Sofi Duberg, Jan Kövamees, Magdalena Ydreborg, Soo Aleman, Katharina Büsch, Marianne Alanko Blomé, Ola Weiland, Jonas Söderholm

Research output: Contribution to journalArticlepeer-review

Abstract

Aims: Hepatitis C virus (HCV) is a slowly progressive disease, often transmitted among people who inject drugs (PWID). Mortality in PWID is high, with an overrepresentation of drug-related causes. This study investigated the risk of death in patients with chronic hepatitis C virus (HCV) infection with or without illicit substance use disorder (ISUD). Methods: Patients with HCV were identified using the Swedish National Patient Registry according to the International Classification of Diseases-10 (ICD-10) code B18.2, with ≤5 matched comparators from the general population. Patients with ≥2 physician visits with ICD-10 codes F11, F12, F14, F15, F16, or F19 were considered to have ISUD. The underlying cause of death was analyzed for alcoholic liver disease, non-alcoholic liver disease, liver cancer, drug-related and external causes, non-liver cancers, or other causes. Mortality risks were assessed using the standardized mortality ratio (SMR) with 95% CIs and Cox regression analyses for cause-specific hazard ratios. Results: In total, 38,186 patients with HCV were included, with 31% meeting the ISUD definition. Non-alcoholic liver disease SMRs in patients with and without ISUD were 123.2 (95% CI, 103.7–145.2) and 69.4 (95% CI, 63.8–75.3), respectively. The significant independent factors associated with non-alcoholic liver disease mortality were older age, being unmarried, male sex, and having ISUD. Conclusions: The relative risks for non-alcoholic liver disease mortality were elevated for patients with ISUD. Having ISUD was a significant independent factor for non-alcoholic liver disease. Thus, patients with HCV with ISUD should be given HCV treatment to reduce the risk for liver disease.

Original languageEnglish
Pages (from-to)574-580
Number of pages7
JournalScandinavian Journal of Gastroenterology
Volume55
Issue number5
Early online date2020 May 1
DOIs
Publication statusPublished - 2020

Subject classification (UKÄ)

  • Gastroenterology and Hepatology

Keywords

  • chronic
  • Hepatitis C
  • liver disease
  • mortality
  • substance abuse

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