1 Immunisation, Hepatitis, and Blood Safety Department, National Infection Service, Public Health England, London, UK.
2 The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London, UK.
3 Blood-borne Virus Unit, Virus Reference Department, National Infection Service, Public Health England, London, UK.
Through record linkage we describe causes of death among persons with diagnosis of HCV in England. Persons ≥1yrs with anti-HCV/HCV-PCR tests reported to PHE sentinel surveillance during 2002-2016 were linked to death registrations from the Office for National Statistics during 2008-2016. We fouind that 8.6% of the 204,265 with evidence of HCV during the study period died. Among them, external causes (accidental poisoning from drugs) and liver disease (end stage liver disease, liver cancer, hepatitis, alcohol and non-alcohol related) were the leading underlying causes of death (18% and 34.5%, respectively); the latter increased to 49.2% if reported anywhere on the death certificate. Median age of death was lower in persons with evidence of HCV than the general population (53 years vs 81 years). A higher proportion of persons with HCV died of external causes, liver disease, and HIV compared to the general population (p<0.001). Potential impact of new HCV treatments was observed as a relative reduction in liver-related deaths in 2016 compared to 2015. Recording of HCV as a contributory cause of death was 28.4% for all underlying causes, but 58.8% among the subgroup who died of liver disease. Data linkage between laboratory diagnosis and deaths data is an important tool for monitoring all-cause mortality among those with HCV and quantifying underreporting of HCV in death registrations. Changes in mortality trends (causes and prematurity) in people with HCV can help evaluate the impact in the UK of HCV treatment scale-up and other interventions to achieve HCV elimination.