Impact of Hepatitis B Virus Infection, Non-alcoholic Fatty Liver Disease, and Hepatitis C Virus Co-infection on Liver-Related Death among People Tested for Hepatitis B Virus in British Columbia: Results from a Large Longitudinal Population-Based Cohort Study
Abstract
:1. Introduction
2. Patients and Methods
2.1. Data Source, Design, and Study Population
2.2. Outcome and Exposure
2.3. Potential Risk Factors
2.4. Statistical Analysis
3. Results
3.1. Study Participant’s Characteristics
3.2. Liver-Related Mortality Rate among Participants
3.3. Effect of HBV Infection on Liver-Related Mortality
3.4. The Effect of NAFLD and HCV Infection in the HBV Liver-Related Mortality
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Overall Study Population | Inverse Probability of Treatment Weighted Dataset * | |||||
---|---|---|---|---|---|---|
Covariates | HBV Negative (n = 1,105,739) | HBV Positive (n = 45,255) | SMD | HBV Negative (n = 45,255) | HBV Positive (n = 45,255) | SMD |
Sex (%) | 0.224 | 0.025 | ||||
Female | 657,289 (55.8) | 20,236 (44.7) | 25,071 (55.4) | 24483 (54.1) | ||
Male | 488,450 (44.2) | 25,019 (55.3) | 20,183 (44.6) | 20,772 (45.9) | ||
Age group, years (%) | 0.331 | 0.033 | ||||
<25 | 257,063 (23.2) | 6021 (13.3) | 10,318 (22.8) | 9820 (21.7) | ||
25–34 | 301,363 (27.3) | 10,634 (23.5) | 12,264 (27.1) | 12,174 (26.9) | ||
35–44 | 215,920 (19.5) | 12,128 (26.8) | 8960 (19.8) | 9413 (20.8) | ||
45–54 | 151,346 (13.7) | 8804 (19.5) | 6290 (13.9) | 6336 (14.0) | ||
55–64 | 96,763 (8.8) | 4677 (10.3) | 3982 (8.8) | 3439 (9.0) | ||
≥65 | 83,284 (7.5) | 2991 (6.6) | 3394 (7.5) | 3439 (7.6) | ||
Birth group (%) | 0.496 | 0.055 | ||||
<1945 | 117,235 (10.6) | 5523 (12.2) | 4842 (10.7) | 5250 (11.6) | ||
1945–1964 | 331,100 (29.9) | 21,107 (46.6) | 13,848 (30.6) | 14,572 (32.2) | ||
1965–1974 | 217,614 (19.7) | 10,183 (22.5) | 8960 (19.8) | 8870 (19.6) | ||
≥1975 | 439,790 (39.8) | 8442 (18.7) | 17,604 (38.9) | 16,563 (36.6) | ||
Ethnicity (%) | 1.189 | 0.031 | ||||
Other * | 867,680 (78.5) | 16,933 (37.4) | 34,756 (76.8) | 34,213 (75.6) | ||
East Asian | 148,383 (13.4) | 26,827 (59.3) | 6924 (15.3) | 7377 (16.3) | ||
South Asian | 89,676 (8.1) | 1495 (3.3) | 3575 (7.9) | 3666 (8.1) | ||
Social deprivation (%) | 0.276 | 0.060 | ||||
Most privileged (Q1) | 243,399 (22.0) | 6975 (15.4) | 8372 (18.5) | 8553 (18.9) | ||
Q2 | 212,109 (19.2) | 6879 (15.2) | 8101 (17.9) | 8508 (18.8) | ||
Q3 | 208,340 (18.8) | 8055 (17.8) | 7965 (17.6) | 7648 (16.9) | ||
Q4 | 220,325 (19.9) | 9970 (22.0) | 9006 (19.9) | 8870 (19.6) | ||
Most deprived (Q5) | 214,970 (19.4) | 12,654 (28.0) | 11,540 (25.5) | 11,812 (26.1) | ||
Unknown | 6596 (0.6) | 722 (1.6) | 272 (0.6) | 272 (0.6) | ||
Material deprivation (%) | 0.183 | 0.024 | ||||
Most privileged (Q1) | 202,776 (18.3) | 10,326 (22.8) | 9820 (21.7) | 8553 (18.9) | ||
Q2 | 196,770 (17.8) | 9053 (20.0) | 8598 (19.0) | 8508 (18.8) | ||
Q3 | 194,886 (17.6) | 7663 (16.9) | 8508 (18.8) | 8644 (19.1) | ||
Q4 | 221,654 (20.0) | 7650 (16.9) | 9051 (20.0) | 9187 (20.3) | ||
Most deprived (Q5) | 283,057 (25.6) | 9841 (21.7) | 8960 (19.8) | 9866 (21.8) | ||
Unknown | 6596 (0.6) | 722 (1.6) | 272 (0.6) | 272 (0.6) | ||
Hepatitis C virus (yes) (%) | 15,906 (1.4) | 4139 (9.1) | 0.349 | 2869 (26.9) | 1665 (29.9) | 0.066 |
HIV† (yes) (%) | 3961 (0.4) | 1318 (2.9) | 0.202 | 226 (0.5) | 272 (0.6) | 0.015 |
Diabetes (yes) (%) | 63,917 (5.8) | 2493 (5.5) | 0.012 | 1655 (15.5) | 887 (15.9) | 0.011 |
Chronic Kidney Disease (yes) (%) | 5342 (0.5) | 466 (1.0) | 0.063 | 226 (0.5) | 272 (0.6) | 0.010 |
Hypertension (%) | 132,663 (12.0) | 4403 (9.7) | 0.073 | 5431 (12.0) | 4707 (10.4) | 0.049 |
Cirrhosis (yes) (%) | 3490 (0.3) | 659 (1.5) | 0.105 | 226 (0.5) | 226 (0.5) | 0.022 |
Decompensated cirrhosis (yes) (%) | 3576 (0.3) | 450 (1.0) | 0.083 | 181 (0.4) | 181 (0.4) | <0.001 |
Gay, bisexual and other men who have sex with men (%) | 65,394 (5.9) | 4,013 (8.9) | 0.232 | 2761 (6.1) | 3620 (8.0) | 0.082 |
History of injection drug use (%) | 28,814 (2.6) | 2318 (5.1) | 0.131 | 1222 (2.7) | 1222 (2.7) | 0.004 |
Alcohol use disorder (%) | 39,599 (3.6) | 1953 (4.3) | 0.038 | 1629 (3.6) | 1448 (3.2) | 0.022 |
Non-alcoholic fatty liver disease (%) | 668 (0.1) | 52 (0.1) | 0.018 | 45 (0.1) | 45 (0.1) | 0.003 |
Overall Study Population | IPW-Dataset ATE ** | |||
---|---|---|---|---|
Covariates | asHR | 95%CI | asHR | 95%CI |
HBV status | ||||
Negative | Ref | Ref | ||
Positive | 3.34 | (3.15, 3.53) | 3.24 | (2.99, 3.50) |
Sex | ||||
Female | Ref | |||
Male | 1.52 | (0.21,10.91) | 1.99 | (1.75, 2.28) |
Age, years | ||||
<25 | Ref | |||
25–34 | 1.46 | (1.19, 1.79) | 1.34 | (0.68, 2.64) |
35–44 | 2.89 | (2.33, 3.57) | 2.3 | (1.18, 4.47) |
45–54 | 4.93 | (3.97,6.13) | 3.06 | (1.57, 5.97) |
55–64 | 7.34 | (5.87, 9.17) | 4.39 | (2.23, 8.66) |
≥65 | 10.32 | (8.20, 13.0) | 6.08 | (3.05, 12.09) |
Birth group | ||||
<1945 | Ref | |||
1945–1964 | 0.68 | (0.64, 0.73) | 0.49 | (0.41, 0.58) |
1965–1974 | 0.27 | (0.24, 0.31) | 0.23 | (0.16, 0.33) |
≥1975 | 0.12 | (0.10, 0.15) | 0.12 | (0.06, 0.24) |
Ethnicity | ||||
East Asian | Ref | |||
South Asian | 1.24 | (1.11, 1.38) | 1.62 | (1.46, 1.78) |
Other *** | 2.03 | (1.90, 2.16) | 0.93 | (0.70, 1.24) |
Material deprivation | ||||
Most privileged(Q1) | Ref | |||
Q2 | 1.26 | (1.18, 1.35) | 1.13 | (0.92, 1.40) |
Q3 | 1.26 | (1.18, 1.35) | 1.03 | (0.84, 1.27) |
Q4 | 1.34 | (1.26, 1.43) | 1.21 | (0.99, 1.47) |
Most deprived(Q5) | 1.49 | (1.40, 1.57) | 1.28 | (1.06, 1.54) |
unknown | 1.46 | (1.20, 1.77) | 1.3 | (0.87, 1.95) |
HCV status | ||||
Negative | Ref | |||
Positive | 3.68 | (3.45, 3.93) | 3.33 | (2.96, 3.76) |
Diabetes | ||||
No | Ref | |||
Yes | 1.68 | (1.59, 1.77) | 1.86 | (1.58, 2.20) |
Chronic Kidney Disease | ||||
No | Ref | |||
Yes | 1 | (0.84,1.18) | 0.99 | (0.67, 1.48) |
Injection Drug Use | ||||
No | Ref | |||
Yes | 1.17 | (1.06,1.27) | 1.12 | (0.88, 1.41) |
Alcohol use disorder | ||||
No | Ref | |||
Yes | 3.58 | (3.38, 3.80) | 2.56 | (2.13, 3.07) |
Non-alcoholic fatty liver disease | ||||
No | Ref | |||
Yes | 4.31 | (3.32, 5.61) | 3.53 | (2.11, 5.91) |
Overall Study Population | IPW-Dataset ** ATE | |||
---|---|---|---|---|
Covariates | asHR | 95%CI | asHR | 95%CI |
HBV and NAFL status | ||||
HBV Negative without NAFLD | Ref | Ref | ||
HBV Negative with NAFLD | 4.49 | (3.35, 6.02) | 4.52 | (3.33, 6.12) |
HBV positive without NAFLD | 3.35 | (3.16, 3.55) | 3.32 | (3.13, 3.53) |
HBV positive with NAFLD | 12.5 | (7.08, 22.07) | 12.08 | (5.87, 24.89) |
HBV and HCV status | ||||
HBV Negative without HCV | Ref | |||
HBV Negative with HCV | 4.69 | (4.37, 5.03) | 4.82 | (4.48, 5.19) |
HBV positive without HCV | 4.36 | (4.09, 4.64) | 4.3 | (4.04, 4.57) |
HBV positive with HCV | 8.4 | (7.62, 9.26) | 8.66 | (7.77, 9.64) |
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Makuza, J.D.; Jeong, D.; Binka, M.; Adu, P.A.; Cua, G.; Yu, A.; Velásquez García, H.A.; Alvarez, M.; Wong, S.; Bartlett, S.; et al. Impact of Hepatitis B Virus Infection, Non-alcoholic Fatty Liver Disease, and Hepatitis C Virus Co-infection on Liver-Related Death among People Tested for Hepatitis B Virus in British Columbia: Results from a Large Longitudinal Population-Based Cohort Study. Viruses 2022, 14, 2579. https://doi.org/10.3390/v14112579
Makuza JD, Jeong D, Binka M, Adu PA, Cua G, Yu A, Velásquez García HA, Alvarez M, Wong S, Bartlett S, et al. Impact of Hepatitis B Virus Infection, Non-alcoholic Fatty Liver Disease, and Hepatitis C Virus Co-infection on Liver-Related Death among People Tested for Hepatitis B Virus in British Columbia: Results from a Large Longitudinal Population-Based Cohort Study. Viruses. 2022; 14(11):2579. https://doi.org/10.3390/v14112579
Chicago/Turabian StyleMakuza, Jean Damascene, Dahn Jeong, Mawuena Binka, Prince Asumadu Adu, Georgine Cua, Amanda Yu, Héctor Alexander Velásquez García, Maria Alvarez, Stanley Wong, Sofia Bartlett, and et al. 2022. "Impact of Hepatitis B Virus Infection, Non-alcoholic Fatty Liver Disease, and Hepatitis C Virus Co-infection on Liver-Related Death among People Tested for Hepatitis B Virus in British Columbia: Results from a Large Longitudinal Population-Based Cohort Study" Viruses 14, no. 11: 2579. https://doi.org/10.3390/v14112579
APA StyleMakuza, J. D., Jeong, D., Binka, M., Adu, P. A., Cua, G., Yu, A., Velásquez García, H. A., Alvarez, M., Wong, S., Bartlett, S., Karim, M. E., Yoshida, E. M., Ramji, A., Krajden, M., & Janjua, N. Z. (2022). Impact of Hepatitis B Virus Infection, Non-alcoholic Fatty Liver Disease, and Hepatitis C Virus Co-infection on Liver-Related Death among People Tested for Hepatitis B Virus in British Columbia: Results from a Large Longitudinal Population-Based Cohort Study. Viruses, 14(11), 2579. https://doi.org/10.3390/v14112579