American Journal of Epidemiology Advance Access originally published online on January 17, 2008
American Journal of Epidemiology 2008 167(6):743-750; doi:10.1093/aje/kwm370
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ORIGINAL CONTRIBUTIONS |
Increased All-Cause, Liver, and Cardiac Mortality among Hepatitis C Virus-seropositive Blood Donors
1 Blood Systems Research Institute, San Francisco, CA
2 Department of Medicine, University of California, San Francisco, CA
3 Blood Systems, Incorporated, Scottsdale, AZ
4 Blood Systems Laboratory, Scottsdale, AZ
5 Department of Laboratory Medicine, University of California, San Francisco, CA
6 Department of Epidemiology/Biostatistics, University of California, San Francisco, CA
Correspondence to Dr. Edward L. Murphy, University of California, San Francisco, and Blood Systems Research Institute, 270 Masonic Avenue, San Francisco, CA 94118 (e-mail: murphy{at}ucsf.edu).
Received for publication June 22, 2007. Accepted for publication November 28, 2007.
Hospital-based studies suggest that hepatitis C virus (HCV) infection causes frequent cirrhosis, hepatocellular carcinoma, and mortality, but epidemiologic studies have shown less morbidity and mortality. The authors performed a retrospective cohort study of 10,259 recombinant immunoblot assay-confirmed, HCV antibody-positive (HCV+), allogeneic blood donors from 1991 to 2002 and 10,259 HCV antibody-negative (HCV–) donors matched for year of donation, age, gender, and Zone Improvement Plan Code (ZIP Code). Vital status through 2003 was obtained from the US National Death Index, and hazard ratios with 95% confidence intervals were calculated by survival analysis. After a mean follow-up of 7.7 years, there were 601 (2.92%) deaths: 453 HCV+ and 148 HCV– (hazard ratio (HR) = 3.13, 95% confidence interval (CI): 2.60, 3.76). Excess mortality in the HCV+ group was greatest in liver-related (HR = 45.99, 95% CI: 11.32, 186.74), drug- or alcohol-related (HR = 10.81, 95% CI: 4.68, 24.96), and trauma/suicide (HR = 2.99, 95% CI: 2.05, 4.36) causes. There was also an unexpected increase in cardiovascular mortality among the HCV+ donors (HR = 2.21, 95% CI: 1.41, 3.46). HCV infection is associated with a significant, threefold increase in overall mortality among former blood donors, including significantly increased mortality from liver and cardiovascular causes. High rates of mortality from drug/alcohol and trauma/suicide causes are likely due to lifestyle factors and may be at least partially preventable.
atherosclerosis; blood donors; Hepacivirus; liver diseases; mortality
Abbreviations: CI, confidence interval; HCV, hepatitis C virus; HCV–, HCV antibody negative; HCV+, HCV antibody positive; HR, hazard ratio; RIBA, recombinant immunoblot assay; ZIP Code, Zone Improvement Plan Code