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
Jean Damascene Makuza,
Dahn Jeong,
Mawuena Binka,
Prince Asumadu Adu,
Georgine Cua,
Amanda Yu,
Héctor Alexander Velásquez García,
Maria Alvarez,
Stanley Wong,
Sofia Bartlett,
Mohammad Ehsanul Karim,
Eric M. Yoshida,
Alnoor Ramji,
Mel Krajden,
Naveed Zafar Janjua
Affiliations
Jean Damascene Makuza
School of Population and Public Health, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada
Dahn Jeong
School of Population and Public Health, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada
Mawuena Binka
Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada
Prince Asumadu Adu
Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada
Georgine Cua
School of Population and Public Health, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada
Amanda Yu
Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada
Héctor Alexander Velásquez García
School of Population and Public Health, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada
Maria Alvarez
Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada
Stanley Wong
Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada
Sofia Bartlett
Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada
Mohammad Ehsanul Karim
School of Population and Public Health, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada
Eric M. Yoshida
Division of Gastroenterology, The University of British Columbia, Vancouver, BC V5Z 1M9, Canada
Alnoor Ramji
Division of Gastroenterology, The University of British Columbia, Vancouver, BC V5Z 1M9, Canada
Mel Krajden
Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada
Naveed Zafar Janjua
School of Population and Public Health, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada
Data on the contribution of hepatitis B virus (HBV) infection and related comorbidities to liver-related mortality in Canada are limited. We assessed the concurrent impact of HBV infection, non-alcoholic fatty liver disease (NAFLD), and hepatitis C virus (HCV) coinfection on liver-related deaths in British Columbia (BC), Canada. We used data from the BC Hepatitis Testers Cohort (BC-HTC). We used Fine–Gray multivariable sub-distributional hazards models to assess the effect of HBV, NAFLD, and HCV coinfection on liver-related mortality, while adjusting for confounders and competing mortality risks. The liver-related mortality rate was higher among people with HBV infection than those without (2.57 per 1000 PYs (95%CI: 2.46, 2.69) vs. 0.62 per 1000 PYs (95%CI: 0.61, 0.64), respectively). Compared with the HBV negative groups, HBV infection was associated with increased liver-related mortality risk in almost all of the subgroups: HBV mono-infection (adjusted subdistribution hazards ratio (asHR) of 3.35, 95% CI 3.16, 3.55), NAFLD with HBV infection, (asHR 12.5, 95% CI 7.08, 22.07), and HBV/HCV coinfection (asHR 8.4, 95% CI 7.62, 9.26). HBV infection is associated with a higher risk of liver-related mortality, and has a greater relative impact on people with NAFLD and those with HCV coinfection. The diagnosis and treatment of viral and fatty liver disease are required to mitigate liver-related morbidity and mortality.
