Selected and summarized by Ronald O. Valdiserri, MD, MPH, Professor, Department of Epidemiology, Rollins School of Public Health, Emory University, and Co-Chair of HepVu.
Dr. Valdiserri reviews significant articles on prevention, public health, and policy advances in viral hepatitis. This month, he highlights “Regional Differences in Mortality Rates and Characteristics of Decedents with Hepatitis B Listed as a Cause of Death, United States, 2000-2019.” Ly KN, Yin S, Spradling PR. JAMA Network Open. 2022
What question(s) does this study address?
It’s well known that untreated chronic hepatitis B virus infection can lead to cirrhosis and liver cancer, but less well recognized is the fact that persons with chronic hepatitis B (CHB) are at increased risk of death from all causes, compared to the general population. A study of over forty-three hundred people with CHB followed for a mean of 5.38 years showed that CHB patients died of all causes, on average, 14 years younger than people in the general population.
In this month’s research review, Ly and her colleagues noted that while national hepatitis B death rates have been “relatively constant” during 1999—2019, differences in mortality rate by region and patient characteristics haven’t been well studied. Examining U.S. Multiple Cause of Death data for decedents with hepatitis B listed as an underlying or contributing cause of death, they sought to answer the question, “were there regional differences in mortality rates and characteristics among decedents with hepatitis B listed as a cause of death in the U.S. during 2000 to 2019?”
What are the major findings of this report/article?
- From 2000 to 2019, there were 35,280 decedents with hepatitis B listed as the cause of death, with 17,797 deaths during the period of 2000 to 2009 and 17,483 deaths in the period 2010 to 2019.
- 4% of decedents were listed as having hepatitis C or HIV coinfection.
- The highest hepatitis B-listed death rates were observed in coastal and Appalachian states.
- Hepatitis B-listed deaths for persons not born in the U.S. (36.7% of the entire group) occurred primarily in the West and East Coast states with large immigrant populations from hyperendemic areas.
- The national median age at hepatitis B death was 60 years. However, the median age at hepatitis B death was younger in the following states: Kentucky (54 years), West Virginia (56 years), Tennessee (57 years), Mississippi (58 years), and Ohio (59 years).
- Compared with 2000 to 2009, during 2010 to 2019, the national hepatitis B-listed death rate declined by 19%. However, significant increases in hepatitis B-listed deaths were observed in both West Virginia (83.8% increase) and Kentucky (69.4% increase) during this period.
What are the implications for the prevention and control of viral hepatitis?
- The 2021 National Viral Hepatitis Strategic Plan calls for a 65% reduction in the rate of hepatitis B deaths by 2030. As such, further reduction in hepatitis B mortality will require improved access to hepatitis-B related care that is continual and lifelong.
- Because decedents born in the U.S. (who constituted two-thirds of all deaths during the period of the study) more frequently had non-liver conditions also listed as an underlying cause of death compared with non-U.S. born decedents, reducing mortality in this group will require attention to other co-morbidities such as respiratory, cardiovascular, and addiction-related conditions.
- Other researchers have also documented increases in hepatitis B infections in some Appalachian states, linked to the opioid epidemic in those areas. Taken together, these findings underscore the importance of integrating viral hepatitis vaccination, testing, linkage to care and treatment services in settings that serve persons who use drugs, including syringe service programs and substance use treatment programs.