The disease burden and mortality from hepatitis C are predicted to increase in the United States as the number of persons with long-standing chronic infection grows. We analyzed hepatitis C mortality rates derived from US Census and multiple-cause-of-death data for 1995-2004. Deaths were considered hepatitis C-related if: (1) hepatitis C was the underlying cause of death, (2) chronic liver disease was the underlying cause and hepatitis C was a contributing cause, or (3) human immunodeficiency virus was the underlying cause and chronic liver disease and hepatitis C were contributing causes. A total of 56,409 hepatitis C-related deaths were identified. Mortality rates increased 123% during the study period (1.09 per 100,000 persons to 2.44 per 100,000), but average annual increases were smaller during 2000-2004 than 1995-1999. After peaking in 2002 (2.57 per 100,000), overall rates declined slightly, but continued to increase among persons aged 55-64 years. Overall increases were greater among males (144%) than females (81%) and among non-Hispanic blacks (170%) and Native Americans (241%) compared to non-Hispanic whites (124%) and Hispanics (84%). The 7,427 hepatitis C deaths in 2004 (mean age: 55 years), corresponded to 148,611 years of potential life lost. The highest mortality rates in 2004 were observed among males, persons aged 45-54 and 55-64 years, Hispanics, non-Hispanic blacks, and non-Hispanic Native American/Alaska Natives. Conclusion: Overall, hepatitis C mortality has increased substantially since 1995. Despite small declines in recent years, rates have continued to increase among persons aged 55-64 years. Hepatitis C is an important cause of premature mortality. (HEPATOLOGY 2008;47:1128-1135.)
H epatitis C virus (HCV) infection is the most common blood-borne infection in the United
States, with an estimated 1.3% of the general US population chronically infected. 1 About 10%-20% of chronically infected persons will develop liver cirrhosis and 1%-5% will develop hepatocellular carci-noma within 20-30 years of infection. 2 In a 2005 report, chronic HCV infection was shown to be the leading indication for liver transplantation in the United States. Alcohol use, age at infection, duration of HCV infection, and male sex are all associated with progression of liver fibrosis, development of cirrhosis, and subsequent mortality among persons with chronic HCV infection. Coinfection with human immunodeficiency virus (HIV) is also an important prognostic factor influencing the course of HCV infection 6 and occurs commonly among persons infected with HCV due to injection drug use and other shared modes of transmission. Advances in antiretroviral therapy have extended the life of many HIV-infected persons, such that persons coinfected with HIV and HCV often live long enough to develop the sequelae of hepatitis C-related chronic liver disease. Liver disease is now a leading cause of death among persons infected with HIV. Several lines of evidence suggest that the disease burden and mortality from chronic HCV infection may increase in the coming years. Comparison of the age-specific prevalence of HCV infection during 1988-1994 and 1999-2002 showed that the peak prevalence of infection