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Hospitalisation of hepatitis C diagnosed persons in Scotland for decompensated cirrhosis: a population-based record-linkage study

McDonald, S.A. and Hutchinson, S.J. and Bird, S.M. and Mills, P.R. and Robertson, C. and Dillon, John and Williams, T. and Goldberg, D.J. and , Chief Scientist Office (Funder) and , Medical Research Council (Funder) (2010) Hospitalisation of hepatitis C diagnosed persons in Scotland for decompensated cirrhosis: a population-based record-linkage study. European Journal of Gastroenterology and Hepatology, 22 (1). pp. 49-57. ISSN 0954-691X

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Although chronic infection with the hepatitis C virus (HCV) may lead to the development of cirrhosis and its complications, little data are available on progression to the decompensated stage in a hetereogenous population. Our aims were to characterise the burden of HCV-related decompensated cirrhosis on the national health care system in Scotland in terms of hospital admissions and length of stay, and to estimate the associations between epidemiological variables and time to first hospital admission/death due to decompensated cirrhosis. We carried out a record-linkage study of 20 969 individuals diagnosed with hepatitis C through laboratory testing between 1991 and 30 June 2006, whose records were linked to the Scottish Morbidity Records hospital discharge database and to national HIV databases. 995 individuals were admitted to hospital and 63 persons died with first-time mention of decompensated cirrhosis during follow-up (median 5.2 years). The number of new cases increased over the period 1996-2005, with an average annual change of 11% (95% CI: 8- 13%). The relative risk of developing decompensated cirrhosis was greater for males (hazard ratio = 1.4, 95% CI: 1.1-1.7), for those co-infected with HIV (2.1, 95% CI: 1.4-3.3), for those with a previous alcohol-related admission, fitted as a time-dependent covariate (5.5, 95% CI: 4.6- 6.6), and for those aged 30+ years (30-39: 3.7, 95% CI: 2.4-5.8; 40-49: 10.0, 95% CI: 6.5-15.6; 50- 59: 20.6, 95% CI: 12.9-32.9, 60+: 37.4, 95% CI: 22.8-61.3). The burden from HCV-infected persons developing cirrhotic complications is increasing, due to the advancing age of this population. Because of the synergistic effect of HCV and excessive alcohol consumption on the development of liver disease, it is essential that policy-makers address alcohol intake when allocating resources for the management of HCV infection.