特定原因死亡率和殘疾的全球趨勢 與乙型肝炎病毒相關的調

StephenW

特定原因死亡率和殘疾的全球趨勢
與乙型肝炎病毒相關的調整後的生命年數
和 2010 年至 2019 年的丙型肝炎病毒


結論：雖然觀察到 HBV 肝硬化和急性 HCV 的死亡率和 DALY 總體下降，但 HBV-HCC、HCV 肝硬化和 HCV-HCC 引起的死亡率持續上升令人擔憂，尤其是在年輕的 HCV 患者中。

AASLD 2021 十一月 12-15

Nicolette Veracruz，中密歇根大學醫學院，Robert G. Gish，美國乙型肝炎基金會，Ramsey C. Cheung，胃腸病學和肝病學部，退伍軍人事務部 Palo Alto Health Care；胃腸病學和肝病學部，斯坦福大學醫學中心醫學系和 Robert J. Wong，胃腸病學和肝病學，退伍軍人事務部 Palo Alto 醫療保健系統；胃腸病學和肝病學，斯坦福大學醫學院

背景：乙型肝炎病毒 (HBV) 和丙型肝炎病毒 (HCV) 感染導致顯著的全球發病率和死亡率。儘管有有效的抗病毒療法，但及時診斷和與護理聯繫方面的差異阻礙了全球消除進展，導致疾病持續進展和死亡率。我們旨在評估 HBV 和 HCV 相關死亡率和殘疾調整生命年 (DALY) 的全球趨勢。

方法：評估了 2010-2019 年全球疾病負擔、損傷和風險因素研究，以確定 HBV 或 HCV 患者的總體死亡率和 DALY，按急性感染、肝硬化或肝細胞癌 (HCC) 分層。 DALY 計算為因過早死亡而損失的生命年數和殘疾年數的總和。死亡率和 DALYs 估計值是年齡標準化的，2010 年至 2019 年的百分比變化按年齡和性別分層。

結果：從 2010 年到 2019 年，觀察到 HBV 肝硬化（-11.8%，95% CI -16.5 至 -6.1，p<0.05）和急性 HCV（-26.1%，95% CI -40.5 至-3.9，p<0.05)。然而，觀察到 HBV-HCC（14.4%，95% CI 1.7-29.0，p<0.05）、HCV 肝硬化（7.5%，95% CI 3.3-12.1，p<0.05）和 HCV 患者的死亡率顯著增加-HCC（15.3%，95% CI 10.6-21.1，p<0.05）。當按性別分層時，男性的 HBV-HCC（16.7%，p<0.05）、HCV 肝硬化（8.3%，p<0.01）和 HCV-HCC（16.5%，p<0.05）死亡率顯著增加。女性的 HBV 肝硬化死亡率顯著下降（-10.0%，p<0.05），但觀察到 HCV 肝硬化和 HCV-HCC 死亡率增加。當按年齡分層時，25-49 歲的成年人 HCV 肝硬化和 HCV-HCC 死亡率顯著增加，而 50-69 歲和年齡 >70 歲的成年人 HBV 肝硬化死亡率顯著下降（表）。從 2010 年到 2019 年，HBV 對成人急性 HBV 和 HBV 肝硬化的 DALYs 的影響分別下降了 14.2% 和 6.7%，但對 HBV-HCC 的影響增加了 20.5%。同樣，急性 HCV 的 DALYs 降低了 28.4%，但成人 HCV 肝硬化和 HCV-HCC 的 DALYs 分別增加了 12.2% 和 21.6%。

結論：雖然觀察到 HBV 肝硬化和急性 HCV 的死亡率和 DALY 總體下降，但 HBV-HCC、HCV 肝硬化和 HCV-HCC 引起的死亡率持續上升令人擔憂，尤其是在年輕的 HCV 患者中。

StephenW

GLOBAL TRENDS IN CAUSE-SPECIFIC MORTALITY AND DISABILITY
ADJUSTED LIFE YEARS RELATED TO HEPATITIS B VIRUS
AND HEPATITIS C VIRUS FROM 2010 TO 2019


Conclusion: While overall declines in mortality and DALYs were observed for HBV cirrhosis and acute HCV, continued rise in mortality due to HBV-HCC, HCV cirrhosis, and HCV-HCC is concerning, particularly among younger individuals with HCV.

AASLD 2021 Nov 12-15

Nicolette Veracruz, College of Medicine, Central Michigan University, Robert G. Gish, Hepatitis B Foundation, USA, Ramsey C. Cheung, Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care; Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center and Robert J. Wong, Gastroenterology and Hepatology, Veterans Affairs Palo Alto Healthcare System; Gastroenterology and Hepatology, Stanford University School of Medicine

Background: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections contribute to significant global morbidity and mortality. Despite availability of effective antiviral therapies, disparities in timely diagnosis and linkage to care have stalled global elimination progress, leading to continued disease progression and mortality. We aim to evaluate global trends in HBV and HCV related mortality and disability adjusted life years (DALYs).

Methods: The Global Burden of Diseases, Injury, and Risk Factors Study from 2010-2019 was evaluated to determine overall mortality rates and DALYs for patients with HBV or HCV, stratified by acute infection, cirrhosis, or hepatocellular carcinoma (HCC). DALYs were calculated as sum of years of life lost due to premature death and years lived with disability. Mortality and DALYs estimates were age-standardized and percent change from 2010 to 2019 was stratified by age and sex.

Results: From 2010 to 2019, significant declines in mortality were observed for patients with HBV cirrhosis (-11.8%, 95% CI -16.5 to -6.1, p<0.05) and acute HCV (-26.1%, 95% CI -40.5 to -3.9, p<0.05). However, significant increases in mortality were observed for patients with HBV-HCC (14.4%, 95% CI 1.7-29.0, p<0.05), HCV cirrhosis (7.5%, 95% CI 3.3-12.1, p<0.05), and HCV-HCC (15.3%, 95% CI 10.6-21.1, p<0.05). When stratified by sex, men experienced significant increases in mortality for HBV-HCC (16.7%, p<0.05), HCV cirrhosis (8.3%, p<0.01), and HCV-HCC (16.5%, p<0.05). Women experienced significant declines in HBV cirrhosis mortality (-10.0%, p<0.05), but increases in HCV cirrhosis and HCV-HCC mortality were observed. When stratified by age, adults age 25-49y had significantly increased HCV cirrhosis and HCV-HCC mortality, whereas adults age 50-69y and age >70y had significant declines in HBV cirrhosis mortality (Table). From 2010 to 2019, the impact of HBV on DALYs decreased by 14.2% and 6.7% for adults with acute HBV and HBV cirrhosis, respectively, but increased by 20.5% for HBV-HCC. Similarly, DALYs decreased by 28.4% for acute HCV, but increased by 12.2% and 21.6% for adults with HCV cirrhosis and HCV-HCC, respectively.

Conclusion: While overall declines in mortality and DALYs were observed for HBV cirrhosis and acute HCV, continued rise in mortality due to HBV-HCC, HCV cirrhosis, and HCV-HCC is concerning, particularly among younger individuals with HCV.