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Abstract Details
Mortality and cause of death in persons with chronic hepatitis B virus infection versus healthy persons from the general population in Denmark
1Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark.
2Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, UCL, London, UK.
3Centre of Excellence for Health, Immunity and Infections (CHIP) and PERSIMUNE, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
4Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark.
5Department of Medical Gastroenterology, Aalborg University Hospital, Aalborg, Denmark.
6Department of Medical Gastroenterology, Zealand University Hospital, Koege, Denmark.
7Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
8Department of Gastroenterology, Herlev Hospital, Herlev, Denmark.
9Department of Infectious Diseases, Herlev Hospital, Herlev, Denmark.
10Department of Lung- and Infectious diseases, North Zealand Hospital, Hilleroed, Denmark.
11Department of Internal Medicine and Infectious Diseases, Zealand University Hospital, Roskilde, Denmark.
12Department of Medical Gastroenterology and Hepatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
13Department of Gastroenterology, Copenhagen University Hospital, Hvidovre, Denmark.
14Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.
15Diagnostic Center, Silkeborg Regional Hospital, Silkeborg, Denmark.
16Department of Internal Medicine, Kolding Hospital, Kolding, Denmark.
17Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.
18Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.
19Clinical Institute, University of Southern Denmark, Odense, Denmark.
20Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Abstract
The study aimed to determine adjusted all-cause mortality and cause of death in persons with chronic hepatitis B virus (HBV) infection compared with age- and sex-matched persons from the general population. We used nationwide registers to identify persons aged ≥18 years with chronic HBV infection in 2002-2017 in Denmark and included 10 age- and sex-matched controls for each. Follow-up was from 6 months after diagnosis until death, emigration, or 31 December 2017. Mortality rate ratios (MRRs) adjusted for age, sex, employment, origin and comorbidity were calculated using Poisson regression. Unadjusted cause-specific mortality rate ratios with 95% confidence intervals were calculated assuming a Poisson distribution. A total of 6988 persons with chronic HBV infection and 69,847 controls were included. During a median follow-up of 7.7 years (range 0.0-15.5), 315 (5%) persons with-and 1525 (2%) without-chronic HBV infection died. The adjusted all-cause MRR was 1.5 (95% CI 1.2-2.0). Persons with chronic HBV infection had increased mortality due to liver disease including hepatocellular carcinoma (MRR 12.3 [8.6-17.7]), external causes (MRR 3.3 [2.5-4.7]), endocrine disease (MRR 3.2 [1.8-5.4]), genitourinary disease (MRR 3.2 [1.2-7.6]) and neoplasms (except hepatocellular carcinoma; MRR 1.6 [1.2-2.0]). In conclusion, this study showed an increased all-cause mortality in persons with chronic HBV infection in comparison with age- and sex-matched persons without chronic HBV infection which remained after adjustment for several confounding factors. Excess mortality was mainly associated with liver disease, but also external factors, endocrine disease, genitourinary disease and neoplasms (excluding hepatocellular carcinoma).