25-Jan-2007
Contact: Lisa Esposito
mailto:Espositohbns-editor@cfah.org
Center for the Advancement of Health
Heavy drinking takes excessive toll on women with hepatitis C
Women tend to survive longer than men if infected with the liver-destroying hepatitis C virus (HCV) -- but if they drink heavily, that survival advantage completely disappears, according to a new study.
"Previous studies indicated that alcohol use is a risk factor for HCV disease progression, but they seldom examined the effect on women and men separately," said lead author Chiung Chen. "Even fewer studies were able to examine the effect of alcohol on HCV mortality. Our study provides empirical evidence to fill the gap."
Chen is a research analyst at CSR Incorporated, which conducted the study under contract with the National Institute on Alcohol Abuse and Alcoholism. The study appears in the February issue of the journal Alcoholism: Clinical and Experimental Research.
The study examined all of the HCV- and heavy-drinking-related deaths in the Multiple Cause of Death files of the National Center for Health Statistics, a total of 132,468 deaths. Women with hepatitis C who were not heavy drinkers died at an average age of 61 -- but those who drank excessively died, on average, at just over 49. For men, hepatitis C in combination with heavy drinking lowered the average age of death from a little over 55 years to 50.
Chen said evidence from previous studies "indicates that men are less likely to clear acute HCV infection than women, so we are a little bit surprised that the slight advantage for women is completely wiped out by heavy drinking."
"The study has the advantages of being massive and of relatively simple design, and applies epidemiological tools not much previously used on this question of HCV, heavy alcohol use and gender relationships," said Alex DeLuca, M.D., who is not associated with the study. "I think the most important findings are the ones that confirm our general understanding from clinical experience and other research approaches."
DeLuca, former chief and medical director of the Smithers Addiction Treatment and Research Center in New York City, said that the research supported earlier findings that women with hepatitis C generally have a slower progression of the disease, but that heavy drinking is in general harder on women than men.
The authors say a study limitation is that treatments like interferon, antiviral medications and liver transplants are often denied to heavy drinkers because they are less likely to be able to benefit -- but this could also contribute to their early deaths.
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By Maia Szalavitz, Contributing Writer Health Behavior News Service
Alcoholism: Clinical and Experimental Research: Contact Mary Newcomb at (317) 375-0819 or mnewcomb-acer@earthlink.net or visit www.alcoholism-cer.com
Chen CM, et al. Alcohol and hepatitis C mortality among males and females in the United States: a life table analysis. Alcohol Clin Exp Res 31(2), 2007.
Abstract
Objective: Evidence from previous studies suggests that heavy alcohol use (HAU) exacerbates the rate of fibrosis progression in the liver and results in increased probability for premature death among patients with hepatitis C virus (HCV) infection.
The current study uses population-based mortality data to investigate whether heavy drinking affects the age of death among individuals with HCV and, if so, whether this effect differs between men and women.
Methods: A total of 7,263,163 death records in the United States between 2000 and 2002 were drawn from the Multiple Cause of Death (MCD) public-use data files compiled by the National Center for Health Statistics (NCHS). International Classification of Diseases, Tenth Revision (ICD-10) codes were used to identify the presence of HCV (B17.1 and B18.2) and HAU (as indicated by alcohol-induced medical conditions, F10 and K70) either as the underlying cause or as one of the contributing causes of death.
The deaths were divided into 4 distinctive cause-of-death categories: HCV without HAU, HAU without HCV, HCV plus HAU, and all others. The mean ages of death and the cumulative probabilities of death derived from multiple-cause life table were compared across these categories.
Results: Hepatitis C virus deaths showed an excessive prevalence of HAU when compared with non-HCV deaths. Compared with deaths of HCV without HAU, the mean age of death was shortened for deaths of HCV plus HAU (from 55.1 to 50.0 years among males, and from 61.0 to 49.1 years among females).
The cumulative probability of death before age 65 was much higher for the latter than the former group (0.91 vs 0.68 among males, and 0.88 vs 0.47 among females). While HCV alone showed a disproportionate effect on premature death in males, HAU presented a stronger effect in females, resulting in a "catching-up" effect that diminished the gender difference in age of HCV death.
Conclusions: This study provides mortality-based evidence to further establish heavy alcohol consumption as one of the key risk factors contributing to premature deaths from HCV in the United States. More importantly, this study, for the first time, presents empirical evidence that alcohol consumption affects men and women differently in HCV mortality.
