Hepatitis C complications: prevalence and disparities in a large US cohort 2006-2014

The burden of hepatitis C virus (HCV)-related cirrhosis, decompensated cirrhosis, and mortality has not been well-described in a large “real world” US population . We investigated trends in the prevalence of cirrhosis and decompensated cirrhosis, and incidence of mortality, among HCV-infected patients in the Chronic Hepatitis Cohort Study (CHeCS) from 2006–2014 .Methods: CHeCS is a longitudinal observational study of hep-atitis patients from 4 large US health systems . Cirrhosis was ascertained using ICD9 codes, liver biopsy reports, and serum markers of fibrosis. Decompensated cirrhosis was ascertained using a set of ICD9 codes that have been validated as predic-tive of decompensated cirrhosis . We used join-point modeling (univariate and multivariate) to identify rates of change in prevalence over time as well as “break points” that indicate different phases of Annual Percentage Change (APC) .Results:Of 11,286 adult HCV-infected patients, prevalence of cirrhosis increased from 10% in 2006 to 28% in 2014 . Join-point analysis identified a breakpoint at 2007, with adjusted APCs of 49 .1 (2006–2007; p\u3c0.05) and 9 .5 (2007–2014; p\u3c0.05) .Prevalence of decompensated cirrhosis increased from 3% in 2006 to 7% in 2014, with two breakpoints (at 2008 and 2012) and three segments, with APCs of 25 .9 (2006–2008; p\u3c0.05), 8 .7 (2008–2012; p\u3c0.05), and 1 .4 (2012–2014) .Incidence of all-cause mortality increased from 1 .1% in 2006 to 3 .1% in 2013, with a breakpoint in 2010 and APCs of 20 .0 (2006–2010; p\u3c0.05) and 4 .2 (2010–2013) . Older patients, Asian/Pacific Islanders, and men all demonstrated higher prevalence of cirrhosis and decompensated cirrhosis. Black patients demonstrated the highest incidence of all-cause mortality. Conclusions: Over the past decade, prevalence of cirrhosis among HCV patients in this US cohort increased almost 3-fold. During the same time period, prevalence of decompensated cirrhosis and incidence of all-cause mortality more than doubled, although the increase in both plateaued in recent years