Attribution of the Causes of Death in People Infected with HIV and/or Hepatitis C in Connecticut, 2003-2007

Introduction: This study examined the causes of death in Connecticut residents who were infected with hepatitis C and/or HIV/AIDS and died between 2003 and 2007. Disease surveillance and mortality data can provide important public health information that may be used to develop important public health programs, policies, or legislation. Underreporting of diseases in mortality data may lead to reduced public health funding. Background: Hepatitis C and HIV/AIDS are two potentially fatal infectious diseases that have been reportable in Connecticut since 1994 and 1981, respectively. Mortality data in Connecticut contain information about the causes of death in a deceased individual, which may or may not encompass all actual causes. Methods: The hepatitis C and HIV/AIDS databases were matched to death data from 2003 to 2007 using Link Plus, electronic matching software from the CDC. The match resulted in three de-identified databases: deceased hepatitis C cases, deceased HIV/AIDS cases, and deceased co-infected cases. Primary and underlying causes of death were examined. Results: HIV disease was the primary cause of death in more than half of HIV/AIDS and co-infected cases while chronic hepatitis C was the primary cause of death in 6.7% of hepatitis C cases. In hepatitis C cases where the primary cause of death was liver disease, hepatitis C was listed as an underlying cause of death in 6.2% of those cases. Similar findings were shown in HIV/AIDS cases when major cardiovascular disease was the primary cause of death. vi Conclusions: HIV/AIDS and hepatitis C are underreported on death certificates in Connecticut, especially when the person died of a condition possibly related to their infection. Hepatitis C was underreported more often than HIV/AIDS. Increased HIV and hepatitis C screening for at-risk persons, comprehensive prevention programs, education about the importance of death certificates and how to complete them, and data sharing between agency programs may help to reduce underreporting in mortality data