Mortality associated with chronic hepatitis C and liver cirrhosis: a retrospective study
DOI:
https://doi.org/10.18203/2320-6012.ijrms20260619Keywords:
Hepatitis C, Liver cirrhosis, Age-adjusted mortality rate, Retrospective study, CDC MCDAbstract
Background: Hepatitis C virus (HCV) infection is a leading cause of mortality; however, its relation with liver cirrhosis remains underexplored. Identifying high-risk populations and developing targeted public health initiatives requires an understanding of this association.
Methods: A retrospective observational study was conducted using the CDC MCD data to assess mortality trends among United States individuals aged 25 years and older between 1999 and 2020. Stratified by age, sex, race, geographical location, and place of death, the study analysed deaths with hepatitis C (ICD-10 code: B18.2) as the primary cause and liver cirrhosis (ICD-10 code: K74) as a contributing factor. Age-adjusted mortality rates (AAMRs) and annual percentage changes (APC) were calculated.
Results: The study period recorded 49,707 deaths. The AAMR declined from 1999 to 2003 (-16.44% APC), followed by an increase from 2003 to 2006 (+163.28%), and significantly decreased from 2006 to 2020 (-5.10%). Mortality was highest among males (64%), white individuals (81.7%), and metropolitan residents (84.9%). Temporal trend analysis revealed a steady decline in overall mortality rates in recent years, with significant variations across demographic and geographic groups.
Conclusions: The mortality trends in hepatitis C with liver cirrhosis have shifted from 1999 to 2020, with notable racial, regional, and gender disparities. This emphasizes the need for targeted prevention interventions and enhanced healthcare access.
Metrics
References
Centers for Disease Control and Prevention. Hepatitis C questions and answers for health professionals. 2020. Available at: https://www. cdc. gov/hepatitis/hcv/hcvfaq.htm. Accessed on 29 September 2025.
Ly KN, Xing J, Klevens RM, Jiles RB, Ward JW, Holmberg SD. The increasing burden of mortality from viral hepatitis in the United States between 1999 and 2007. Ann intern med. 2012;156(4):271-8. DOI: https://doi.org/10.7326/0003-4819-156-4-201202210-00004
Assoumou SA, Tasillo A, Leff JA, Schackman BR, Drainoni ML, Horsburgh CR, et al. Cost-effectiveness of one-time hepatitis C screening strategies among adolescents and young adults in primary care settings. Clin Infect Dis. 2018 ;66(3):376-84. DOI: https://doi.org/10.1093/cid/cix798
Andrilla CH, Moore TE, Patterson DG, Larson EH. Geographic distribution of providers with a DEA waiver to prescribe buprenorphine for the treatment of opioid use disorder: a 5‐year update. J Rural Health. 2019;35(1):108-12. DOI: https://doi.org/10.1111/jrh.12307
Westbrook RH, Dusheiko G. Natural history of hepatitis C. J hepatol. 2014;61(1):S58-68.
Scaglione S, Kliethermes S, Cao G, Shoham D, Durazo R, Luke A, Volk ML. The epidemiology of cirrhosis in the United States: a population-based study. J clin gastroenterol. 2015;49(8):690-6. DOI: https://doi.org/10.1097/MCG.0000000000000208
Bataller R, Brenner DA. Liver fibrosis. J Clin Invest. 2005;115(2):209-18.
Centers for Disease Control and Prevention. CDC Wonder. 2026. Available at: http://wonder.cdc.gov. Accessed on 29 September 2025.
De Lusignan S, Liyanage H, Di Iorio CT, Chan T, Liaw ST. Using routinely collected health data for surveillance, quality improvement and research: Framework and key questions to assess ethics and privacy and enable data access. J Innov Health Inform. 2016;22(4):426-32. DOI: https://doi.org/10.14236/jhi.v22i4.845
U.S. Department of Health and Human Services. 45 CFR 46 – Protection of Human Subjects. 2025. Available at: https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/. Accessed on 29 September 2025.
Office for Human Research Protections (OHRP). Guidance on Research Involving Coded Private Information or Biological Specimens. 2008. Available at: https://www.hhs.gov/ohrp/regulations-and-policy/guidance/research-involving-coded-private-information/index.html. Accessed on 29 September 2025.
Deoghare S. Virtual Research Designs and IRB Requirements: Clarifying What Truly Needs Ethics Approval. 2025.
Alter MJ. Epidemiology of hepatitis C virus infection. World J gastroenterol. 2007;13(17):2436-41. DOI: https://doi.org/10.3748/wjg.v13.i17.2436
Westbrook RH, Dusheiko G. Natural history of hepatitis C. J hepatol. 2014;61(1):S58-68. DOI: https://doi.org/10.1016/j.jhep.2014.07.012
El-Serag HB. Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterology. 2012; 142(6):1264-73. DOI: https://doi.org/10.1053/j.gastro.2011.12.061
Bataller R, Brenner DA. Liver fibrosis. J Clin Invest. 2005;115(2):209-18. DOI: https://doi.org/10.1172/JCI24282
Younossi ZM, Stepanova M, Feld J, Zeuzem S, Sulkowski M, Foster GR, et al. Sofosbuvir and velpatasvir combination improves patient-reported outcomes for patients with HCV infection, without or with compensated or decompensated cirrhosis. Clin Gastroenterol Hepatol. 2017;15(3):421-30. DOI: https://doi.org/10.1016/j.cgh.2016.10.037
Kanwal F, Kramer JR, El-Serag HB, Frayne S, Clark J, Cao Y, et al. Race and gender differences in the use of direct acting antiviral agents for hepatitis C virus. Clin Infect Dis. 2016;63(3):291-9. DOI: https://doi.org/10.1093/cid/ciw249
Ly KN, Hughes EM, Jiles RB, Holmberg SD. Rising mortality associated with hepatitis C virus in the United States, 2003–2013. Clin infect dis. 2016 ;62(10):1287-8. DOI: https://doi.org/10.1093/cid/ciw111
Chen SL, Morgan TR. The natural history of hepatitis C virus (HCV) infection. Int J med sci. 2006;3(2):47-52. DOI: https://doi.org/10.7150/ijms.3.47
Seeff LB. Natural history of chronic hepatitis C. Hepatology. 2002;36(5):s35-46. DOI: https://doi.org/10.1053/jhep.2002.36806
Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhnert WL, Alter MJ. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann intern med. 2006;144(10):705-14. DOI: https://doi.org/10.7326/0003-4819-144-10-200605160-00004
Kolluri VM, Bhamat A, Gohel C, Bindu G, Enumula D. A Retrospective Study of the Temporal Trends in Mortality in Patients with Non-alcoholic Fatty Liver Disease and Liver Cirrhosis in the United States Using the Centres for Disease Control and Prevention's (CDC) Multiple Causes of Death (MCD) Database. Cureus. 2025;17(8):e90861. DOI: https://doi.org/10.7759/cureus.90861