Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia.
Henry Ford Health System, Detroit Michigan.
Geisinger Health System, Danville, Pennsylvania.
Kaiser Permanente-Northwest, Portland, Oregon.
Kaiser Permanente-Hawaii, Honolulu.
According to death certificates, approximately 1800 persons die from hepatitis B annually in the United States (US); however, this figure may underestimate the true mortality from chronic hepatitis B (CHB).
We analyzed data from CHB patients seen in the Chronic Hepatitis Cohort Study (CHeCS) between January 1, 2006 and December 31, 2013. We compared overall and cause-specific death rates and mean age at death between CHeCS CHB decedents and US decedents from the multiple cause of death (MCOD) file.
A total of 4389 CHB patients were followed for a mean of 5.38 years through December 31, 2014; 492 (11%) CHB patients died after a mean follow-up of 3.00 years. Compared to survivors, decedents were older, more likely to be White (40.6%), African-American (27.1%) or male (74.2%), and more likely to have cirrhosis (59.8%), diabetes (27.2%), alcohol abuse (17.7%), hepatocellular carcinoma (17.5%) or liver transplant (5.7%); whereas survivors were more likely to be Asian (48.8%) (all, p<0.001). CHB patients died at an average age of 59.8 years, 14 years younger than the general US population and at higher rates for all causes (RR=1.854 [95% CI, 1.851 - 1.857]) and liver-related causes (RR=15.91 [95% CI, 15.81 - 16.01]). Only 19% of CHB decedents and 40% of those dying of liver disease had hepatitis B reported on their death certificates.
Compared to the general population, CHB patients die at a younger age and at higher rates from all causes and liver-related causes. Death certificates underrepresent the true mortality from CHB.