Chronic Hepatitis B Mortality May Be Under-Represented on Death Certificates

Although underestimated based on death certificate data in the United States, patients with chronic hepatitis B (CHB) die at a younger age and at higher rates from all causes and liver-related causes compared with the general population, according to a study published in Clinical Infectious Diseases.¹

Every year, approximately 1800 death certificates list hepatitis B virus as an underlying or contributing cause of death, but this may be an underestimate of the true mortality related to CHB.^2,3 Using data from 4 large health systems in the United States, researchers compared overall and cause-specific death rates and mean age at death in patients with CHB and the general population.¹

Researchers found that patients with CHB died at higher rates from all causes, as well as liver-related causes, including liver cancer, when compared with the general population. Individuals with CHB also died, on average, 14 years younger than decedents of the general population.

Of CHB decedents, 48% died at an average age of 60, with liver disease listed as an underlying or contributing cause on the death certificate. However, only 40% of CHB decedents who died because of liver disease had hepatitis B reported on their death certificates, which indicated that national vital statistic data may underestimate the mortality burden of hepatitis B viral infection.

Thus, elimination of hepatitis B remains as a national public health goal.^4,5

“Clinicians can contribute to elimination of hepatitis B by: (1) vaccinating all unvaccinated high risk adults for HBV; (2) appropriate screening of all high-risk persons for HBV; and (3) assuring that persons with HBV receive posttest counseling and clinical care,⁶” concluded the researchers.¹

References

1. Bixler D, Zhong Y, Ly KN, et al. Mortality among patients with chronic hepatitis B (CHB) infection: the Chronic Hepatitis Cohort Study (CHeCS) [published online July 28, 2018]. Clin Infect Dis. doi:10.1093/cid/ciy598
2. Centers for Disease Control and Prevention (CDC). Viral hepatitis statistics and surveillance. www.cdc.gov/hepatitis/statistics/index.htm Accessed August 27, 2018.
3. Manos MM, Leyden WA, Murphy RC, Terrault NA, Bell BP. Limitations of conventionally derived chronic liver disease mortality rates: results of a comprehensive assessment. Hepatology 2008; 47:1150-1157.
4. National Academies of Sciences, Engineering, and Medicine. 2016. Eliminating the public health problem of hepatitis B and C in the United States: Phase one report. The National Academies Press. Published April 11, 2016. http://nationalacademies.org/hmd/Reports/2016/Eliminating-the-Public-Health-Problem-of-Hepatitis-B-and-C-in-the-US.aspx. Accessed August 27, 2018.
5. National Academies of Sciences, Engineering, and Medicine. 2017. A national strategy for the elimination of hepatitis B and C. The National Academies Press. Accessed August 27, 2018.
6. Abara WE, Qaseem A, Schillie S, McMahon BJ, Harris AM. Hepatitis B vaccination, screening, and linkage to care: best practice advice from the American College of Physician and the Center for Disease Control and Prevention. Ann Intern Med 2017;167:794-804.