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Abstract Details
Estimating the attributable fraction of cirrhosis and hepatocellular carcinoma due to hepatitis B and C
J Viral Hepat. 2021 May 18. doi: 10.1111/jvh.13545. Online ahead of print.
Erika Duffell1, Helena Cortez-Pinto2, Marieta Simonova3, Olav Dalgard4, Elin Hoffmann Dahl5, Catherine de Martel6, Antons Mozalevskis7, Maria Buti8, Slava Pavlova3, Tnaiq Hadzhilova3, Carolina Simões2, Krum Katzarov3, Otilia Mardh1
Author information
1European Centre for Disease Prevention and Control, Stockholm, Sweden.
2Clínica Universitária de Gastrenterologia, Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
3Department of Gastroenterology, HPB and Transplant Surgery, Military Medical Academy, Sofia, Bulgaria.
4Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway.
5Department of Medicine, Haukeland University Hospital, Bergen, Norway.
6International Agency for Research on Cancer, Lyon, France.
7World Health Organization Regional Office for Europe, Copenhagen, Denmark.
8Liver Unit, Hospital General Universitario Vall d'Hebron and CIBEREHD, Instituto Carlos III, Barcelona, España.
Abstract
A goal of the WHO strategy on the elimination of hepatitis as a public threat is a 65% reduction in the attributable mortality. Deaths related to hepatitis B and C infections are mostly due to decompensated cirrhosis and hepatocellular carcinoma (HCC) but accurately measuring mortality is challenging as death certificates often do not capture the underlying disease. The aim of this collaborative study between European Centre for Disease Prevention and Control (ECDC) and the European Association for the Study of the Liver (EASL) was to assess a WHO-developed protocol to support countries in implementing studies to collect data on the fraction of cirrhosis and hepatocellular carcinoma attributable to hepatitis B and C. Three sentinel sites (in Bulgaria, Norway and Portugal) collected data for patients first admitted or seen in their centres during 2016. Patients with cirrhosis or HCC were identified through patient files or healthcare databases using ICD-10 codes. The proportion of patients with cirrhosis and HCC who tested positive for HBV and HCV were calculated to estimate the aetiological fractions. After the pilot study was completed, each site was asked about the feasibility and acceptability of the protocol. A total of 1249 patients presenting with cirrhosis and/or HCC were evaluated across the three sites. The prevalence of HBV and HCV among cases of cirrhosis showed that in Norway and Portugal, HCV was responsible for about one quarter of the cases, whereas in Bulgaria, HBV was more common. HCV was responsible for more than one-third of HCC cases in Norway and Portugal, while in Bulgaria HBV was more frequent as HCC underlying cause. Results obtained during the pilot study were comparable to published estimates obtained through statistical modelling or meta-analyses. Several challenges were reported from the sites involved in the pilot including the considerable time needed for reviewing the hospital records and extracting the patient's data.The pilot demonstrated the feasibility of collecting data on the prevalence of HBV and HCV infection among patients with cirrhosis and HCC in sentinel sites. This method can be used to estimate mortality attributable to HBV and HCV for elimination monitoring. Where easily implementable, sentinel studies are the best way to empower countries, get up-to date data, and closely monitor the changes in the attributable fraction at a country level.