Primary Liver Cancer and Death Among People with Hepatitis C in Philadelphia, 2003-2012

BACKGROUND:  In the United States, 3.2 million people are infected with hepatitis C virus (HCV). Sustained liver inflammation results in cirrhosis in 20% of HCV infected individuals, increasing their risk for hepatocellular carcinoma (HCC) and other primary liver cancers (PLC). This study assesses the role of particular factors on long-term outcomes for individuals with chronic HCV infection.

METHODS: For 2003-2012, HCV surveillance registry data (HCV RNA or Antibody-positive) were matched to cancer registry listings and death certificates of Philadelphia residents on DOB, name, and address. Individual characteristics (gender, race, marital status) were compared across a number of groups based on HCV status and outcome: (1) HCV Only, (2) HCV + Death, (3) HCV + PLC, (4) HCV + PLC + Death, (5) PLC Only, and (6) PLC + Death. Age at and time to sentinel events (HCV diagnosis, PLC diagnosis, and death) were calculated.  

RESULTS:  Individuals with HCV accounted for a third of all PLC diagnoses made during the study period. HCV-infected patients were also 2.8 times (95% CI: 1.8-4.5) more likely to have liver cancer detected before age 65, and to have an earlier age of death, than individuals without HCV. The odds of having an HCV diagnosis, PLC diagnosis, and dying during the study period, and the time between each diagnosis and death were greatly influenced by demographic characteristics. For males, unmarried individuals, and non-Hispanic blacks, HCV was more common and more often associated with PLC diagnosis and death.  Males and unmarried individuals also tended to be diagnosed with HCV, PLC, and to die at a younger age. For race, age at PLC diagnosis and death were influenced by HCV status: blacks without HCV experienced outcomes at a younger age than whites, while HCV-positive blacks had later PLC diagnosis and death dates than HCV-positive whites.

CONCLUSIONS:  These results identify populations at greatest risk for HCV and PLC, including males, non-Hispanic blacks, and unmarried individuals. Findings also suggest that HCV-positive non-Hispanic whites may be at greater risk of dying from non-cancer related causes including opioid-induced deaths. This study highlights the need for education and screening programs that target particular at-risk populations. Findings also illustrate that widespread public health actions to prevent HCV infection could have a substantial effect on the burden of PLC in Philadelphia.