The burden of hepatitis C in Sweden: a national study of inpatient care

TLDR

Hepatitis C spread in Sweden during the 1970s foreshadowed a rise in serious liver complications in the 2000s. The study aimed to quantify the inpatient burden of HCV in Sweden, track temporal changes, and compare it to a noninfected cohort. Using national surveillance data, 43,000 HCV patients were matched to 215,000 noninfected controls and Cox regression assessed hospitalization hazards. HCV patients had 4‑fold higher overall admission risk, 78‑fold higher liver‑related risk, and 41‑fold higher liver‑cancer risk, with 45% of episodes psychiatric, and serious liver complications rose sharply in the 2000s.

Abstract

The spread of hepatitis C virus (HCV) in Sweden in the 1970s indicated that serious liver complications (SLC) would increase in the 2000s. The aim of this study was to analyse the burden of HCV-associated inpatient care in Sweden, to demonstrate the changes over time and to compare the findings with a noninfected population. The HCV-cohort (n: 43,000) was identified from the national surveillance database 1990-2006, and then linked to national registers to produce an age-, sex-, and region-matched noninfected comparison population (n: 215,000) and to obtain information on demographics, cancers, inpatient care and prescriptions. Cox regression was used to estimate the likelihood (hazard ratios) for admission to hospital in the HCV compared with the noninfected cohort. The hazard ratios were 4.03 (95% CI: 3.98-4.08) for all care, 77.52 (71.02-84.60) for liver-related care and 40.74 (30.58-54.27) for liver cancer care. The admission rate in the HCV-cohort compared with the noninfected cohort, the rate ratio (age- and sex-adjusted) for all inpatient care was 5.91 (95% CI: 5.87-5.94), and the rate ratio for liver-related care was 70.05 (66.06-74.28). In the HCV-cohort, 45% of all episodes were for psychiatric, mostly drug-related, care. Inpatient care for SLC increased in the 2000s. To conclude, drug-related care was common in the HCV-infected cohort, the demand for liver-related care was very high, and SLC increased notably in the 2000s, indicating that the burden of inpatient care from serious liver disease in HCV-infected individuals in Sweden is an increasing problem.