Objectives: Although chronic infection with the hepatitis C virus (HCV) may lead to the development of cirrhosis and its complications, little data are available on progression to the decompensated stage in a hetereogeneous population. Our aims were to characterize the burden of HCV-related decompensated cirrhosis on the national health care system in Scotland in terms of hospital admissions and length of stay, and to estimate the associations between epidemiological variables and time to the first hospital admission/death with mention of decompensated cirrhosis.
Methods: We carried out a record-linkage study of 20 969 individuals diagnosed with hepatitis C through laboratory testing between 1991 and 30 June 2006, whose records were linked to the Scottish Morbidity Records hospital discharge database and to national HIV databases.
Results: Nine hundred and ninety-five individuals were admitted to hospital and 63 individuals died with first-time mention of decompensated cirrhosis during follow-up (median 5.2 years). The number of new cases increased over the period 1996–2005, with an average annual change of 11% [95% confidence interval (CI): 8–13]. The relative risk of developing decompensated cirrhosis was greater for men (hazard ratio = 1.4, 95% CI: 1.1–1.7), for those coinfected with HIV (hazard ratio = 2.1, 95% CI: 1.4–3.3), for those with a prior alcohol-related admission, fitted as a time-dependent covariate (hazard ratio = 5.5, 95% CI: 4.6–6.6) and for those aged 30 years or older (30–39 years: hazard ratio = 3.7, 95% CI: 2.4–5.8; 40–49 years: hazard ratio = 10.0, 95% CI: 6.5–15.6; 50–59 years: hazard ratio = 20.6, 95% CI: 12.9–32.9, 60 years or older: hazard ratio = 37.4, 95% CI: 22.8–61.3).
Conclusion: The burden from HCV-infected individuals developing cirrhotic complications is increasing because of the advancing age of this population. On account of the synergistic effect of HCV and excessive alcohol consumption on the development of liver disease, it is essential that policy-makers address alcohol intake when allocating resources for the management of HCV infection.
aHealth Protection Scotland
bDepartment of Statistics and Modelling Science, University of Strathclyde
cGartnavel General Hospital, Glasgow
dMRC Biostatistics Unit, Institute of Public Health, Cambridge
eNinewells Hospital and Medical School, Dundee, UK
Correspondence to Dr Scott A. McDonald, Health Protection Scotland, Clifton House, Clifton Place, Glasgow G3 7LN, UK
Tel: +44 141 300 1106; fax: +44 141 300 1170;
Received 14 March 2009 Accepted 22 June 2009