A Record Linkage Study on the Causes of Death in People With HCV in England

Hepatitis C virus
Hepatitis C virus
Data that were cross-referenced to monitor all-cause mortality between death records and laboratory diagnoses in the United Kingdom showed that liver disease is reduced once treatment for hepatitis C virus (HCV) infection is implemented, but researchers believe more research is needed to meet the World Health Organization’s global HCV elimination goal.

Data linkage between laboratory diagnosis and death data is an important tool for monitoring all-cause mortality in patients with hepatitis C virus (HCV) and quantifying under-reporting of HCV on death registers,  according to study results published in the Journal of Viral Hepatitis.1

In the United Kingdom, death from liver disease and hepatocellular carcinoma (HCC) has been increasing, mainly due to alcohol use, obesity, and viral hepatitis.2 However, in 2016, a 3% decrease in deaths from HCV-related end-stage liver disease (ESLD) and HCC was observed, with provisional data suggesting a further fall of 11% in 2017, likely as a result of newer, more effective antiviral treatments.3 Robust estimates of morbidity from HCV-associated mortality are essential for healthcare planning, monitoring, and evaluation of services, and are an important metric in the World Health Organization (WHO) global strategy for elimination of viral hepatitis by 2030.4

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Thus, researchers aimed to use data linkage between the sentinel surveillance of blood-borne virus testing dataset (2002-2016) and the national death register (2008-2016) to describe the number and causes of death in people with a diagnosis of HCV in England.1 They found that of the 204,265 individuals with evidence of HCV during that period, 8.6% died. External causes (18%) and liver disease (34.5%) were the leading underlying causes of death in those patients. A potential impact of direct-acting antivirals (DAAs) was observed, as there was a relative reduction in liver-related deaths in 2016 compared with 2015.

The investigators concluded that, “Our data provide a baseline and supportive evidence of the early impact of the new DAAs on HCV‐associated liver‐related mortality.”1 They added that, “Our ability to monitor and confidently interpret changes in causes of death is critical as HCV prevention and treatment interventions are ramped up to achieve the WHO global HCV elimination targets and goal.”


1. Simmons R, Ireland G, Ijaz S, Ramsay M, Mandal S; on behalf of the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne, Sexually Transmitted Infections. Causes of death among persons diagnosed with hepatitis C infection in the pre‐ and post‐DAA era in England: A record linkage study [published online April 23, 2019]. J Viral Hepat. doi:10.1111/jvh.13096

2. Public Health England. Liver disease profiles. https://fingertips.phe.org.uk/profile/liver-disease. Accessed May 22, 2019.

3. Public Health England. Hepatitis C in England 2018 report.  https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/693917/HCV_in_England_2018.pdf. Accessed May 22, 2019.

4. World Health Organisation. Global health sector strategy on viral hepatitis 2016–2021. https://apps.who.int/iris/bitstream/handle/10665/246177/WHO-HIV-2016.06-eng.pdf;jsessionid=5DCF1F806B9877A56726A805832070C5?sequence=1. Accessed May 22, 2019.