Mortality after Chronic Hepatitis B Virus Infection: A Linkage Study Involving 2 Million Parous Women from Taiwan

• Published in: The Journal of infectious diseases Vol. 201; no. 7; pp. 1016 - 1023
• Main Authors: Fwu, Chyng-Wen, Chien, Yin-Chu, Nelson, Kenrad E., Kirk, Gregory D., You, San-Lin, Kuo, Hsu-Sung, Feinleib, Manning, Chen, Chien-Jen
• Format: Journal Article
• Language: English
• Published: Oxford The University of Chicago Press 01.04.2010; University of Chicago Press; Oxford University Press
• Subjects: Adult; Biological and medical sciences; Cancer; Causes of death; Cohort Studies; Death; Female; Fundamental and applied biological sciences. Psychology; Hepatitis; Hepatitis Antibodies - blood; Hepatitis antigens; Hepatitis B Surface Antigens - immunology; Hepatitis B virus; Hepatitis B virus - isolation & purification; Hepatitis B, Chronic - blood; Hepatitis B, Chronic - immunology; Hepatitis B, Chronic - mortality; Hepatitis viruses; Human viral diseases; Humans; Infections; Infectious diseases; Kaplan-Meier Estimate; Liver diseases; Medical sciences; Microbiology; Mortality; Mothers; Pregnancy; Pregnancy Complications, Infectious - blood; Pregnancy Complications, Infectious - epidemiology; Prevalence; Proportional Hazards Models; Risk Assessment; Taiwan - epidemiology; Viral diseases; Viral hepatitis; VIRUSES; Asia; Taiwan; Far east; Human; Viral hepatitis B; Infection; Subtropical zone; Viral hepatitis A; Viral disease; Digestive diseases; Hepatic disease; Female
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1086/651231

Background. Few studies have evaluated survival rates among women who have chronic hepatitis B virus infection. We investigated the overall and disease-specific mortality rates in a nationwide cohort of women after they were screened for hepatitis B surface antigen (HBsAg) during pregnancy. Methods. HBsAg prenatal screening data were available for 2,087,994 women in Taiwan between 1 January 1986 and 31 March 2000 in the National Hepatitis B Vaccination Registry. Their vital status and cause of death were ascertained by computerized linkage with the National Death Certification Registry. Cox proportional hazards models were used to estimate the association between HBsAg status and specific causes of death. Results. Overall, 14,524 deaths were identified after a mean of 11.43 years of follow-up. The age-adjusted hazard ratio for mortality among HBsAg carriers compared with noncarriers was 1.24 (95% confidence interval [CI], 1.19–1.30), 6.59 (95% CI, 5.70–7.61), and 1.09 (95% CI, 1.04–1.14) for all-cause, liver-specific, and non-liver-related deaths, respectively. In addition to liver-specific causes, a significantly increased risk of mortality from non-Hodgkin lymphoma (P<.001) and gallbladder and extrahepatic bile duct cancer (P = .01) was observed. Conclusions. Our study found an excess risk of death due to both liver-specific and non-liver-related causes for HBsAg-positive women in Taiwan. Effective prevention and treatment of hepatitis B virus infection is an important public health priority.