在美国，慢性乙型肝炎感染的成年人死亡率：基于人群的研

StephenW

Mortality in Adults With Chronic Hepatitis B Infection in the United States: A Population-Based Study
Kali Zhou  1   2 , Jennifer L Dodge  1 , Joshua Grab  2 , Eduard Poltavskiy  2   3 , Norah A Terrault  1
Affiliations
Affiliations

    1
    University of Southern California, Los Angeles, CA, USA.
    2
    University of California, San Francisco, San Francisco, CA, USA.
    3
    University of California, Davis, Davis, CA, USA.

    PMID: 32432816 DOI: 10.1111/apt.15803

Abstract

Background: Chronic hepatitis B infection is an important contributor to mortality in the United States, yet impact of available and effective oral antivirals on mortality among infected individuals is unknown.

Aims: To compare risks and predictors of mortality in a recent time period between those with chronic, prior and no hepatitis B infection.

Methods: This is a population-based cohort study of National Health and Nutrition Examination Surveys participants between 1999 and 2014 linked to National Death Index data. Adults aged 20 years or older with hepatitis B serologic testing were included. Outcomes of all-cause and liver-related mortality were evaluated using Cox regression.

Results: Of 39 206 participants, 192 (0.5%) had chronic and 2694 (6.9%) had prior hepatitis B infection. The all-cause age/sex-standardised mortality rates for chronic, prior and uninfected were 21.4, 15.1 and 11.8 per 1000 person-years respectively. Liver-related mortality occurred at respective rates of 4.1, 0.3 and 0.1 per 1000 person-years. In multivariable analyses, those with chronic infection had 1.9-fold (95% CI 1.1-3.3) increased hazard of all-cause mortality and 13.3-fold (95% CI 3.9-45.5) increased hazard of liver-related mortality compared to uninfected. Predictors of all-cause mortality among chronic infection included heavy alcohol use (HR 18.3, 95% CI 3.3-100.6) and higher alanine aminotransferase (HR 1.02, 95% CI 1.00-1.03).

Conclusions: Mortality among adults living with chronic hepatitis B infection still exceeds that of uninfected despite availability of improved therapeutics. Identification of chronic infection, initiation of treatment among eligible and modulation of co-factors for disease progression are needed to improve survival.

© 2020 John Wiley & Sons Ltd.

StephenW

在美国，慢性乙型肝炎感染的成年人死亡率：基于人群的研究
Kali Zhou 1 2，Jennifer L Dodge 1，Joshua Grab 2，Eduard Poltavskiy 2 3，Norah A Terrault 1
隶属关系
隶属关系

    1个
    美国加利福尼亚州南加州大学洛杉矶分校。
    2
    加州大学旧金山分校，美国加利福尼亚州旧金山。
    3
    加利福尼亚大学戴维斯分校，美国加州戴维斯。

    PMID：32432816 DOI：10.1111 / apt.15803

抽象

背景：在美国，慢性乙型肝炎感染是导致死亡的重要因素，但尚不知道有效和有效的口服抗病毒药物对感染个体死亡率的影响。

目的：比较近期，慢性，先前和无乙型肝炎感染者之间的风险和死亡预测因素。

方法：这是一项基于人群的队列研究，研究对象是1999年至2014年间与国家死亡指数数据相关的国家健康和营养检查调查参与者。包括年龄在20岁或以上且接受乙型肝炎血清学检查的成年人。使用Cox回归评估全因和肝脏相关死亡率的结果。

结果：在39206名参与者中，有192名（0.5％）患有慢性病，有2694名（6.9％）具有先前的乙型肝炎感染。慢性，先前和未感染的全因年龄/性别标准化死亡率分别为每千人年21.4、15.1和11.8。肝相关死亡率分别为每1000人年4.1、0.3和0.1。在多变量分析中，与未感染者相比，慢性感染者的全因死亡率危险增加了1.9倍（95％CI 1.1-3.3），与肝有关的死亡率增加了13.3倍（95％CI 3.9-45.5）。慢性感染中全因死亡率的预测因素包括大量饮酒（HR 18.3，95％CI 3.3-100.6）和较高的丙氨酸氨基转移酶（HR 1.02，95％CI 1.00-1.03）。

结论：尽管可以使用改良的治疗方法，但慢性乙型肝炎感染成人的死亡率仍超过未感染者。需要鉴定慢性感染，在合格的患者中开始治疗以及调节疾病进展的辅助因子以提高生存率。

分级为4 +©2020 John Wiley＆Sons Ltd.

StephenW

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/apt.15803