Using data from the NHANES survey conducted by the National Center for Health Statistics, Samer El-Kamary, MD, MPH, of the University of Maryland School of Medicine and his colleagues looked at causes of death among 9,378 adults—203 of whom had chronic HCV infection—between ages 17 and 59. All subjects were participants in the NHANES Survey III, which took place between 1988 and 1994, with follow-up available through 2006.

There were 614 reported deaths during the nearly 15-year follow-up period. Forty-four of the deaths occurred among those with chronic HCV infection; nine of the deaths were liver related, whereas 35 deaths were attributable to HIV, diabetes, heart disease, cancer and other causes.

Applying these data to the general population, El-Kamary and his colleagues estimated there are 9,500 liver-related deaths in the United States each year. While this rate is lower than the 12,000 annual HCV-related deaths estimated by the U.S. Centers for Disease Control and Prevention (CDC), it is higher than the HCV-related death rates estimated by other studies.

According to calculations by El-Kamary’s group, the death rate from liver- and non-liver-related causes was more than two times higher among those with chronic HCV infection, compared with those who have never been infected with the virus.

Not surprisingly, liver-rated death rates were more than 26 times higher among those with chronic HCV infection. However, non-liver-related deaths were nearly two times higher among those with chronic hepatitis C, a finding that has not been documented by other research teams looking at death from any cause among (non-institutionalized) people with chronic HCV infection.

They found that males, non-Hispanic blacks, people living with HIV, high school drop-outs, single people and cigarette smokers were more likely to be have chronic hepatitis C or to have been infected with the virus at some point in the past.

Given the higher all-cause mortality rates among people with hepatitis C, the authors concluded by suggesting increased HCV testing, early treatment initiation and more vigilant medical monitoring for people with hepatitis C, particularly those with other illnesses.