A cohort study of hepatitis C virus (HCV) infection in an HCV epidemic area of Japan: age and sex-related seroprevalence of anti-HCV antibody, frequency of viremia, biochemical abnormality and histological changes.
ABSTRACT We studied the age- and sex-specific prevalence of hepatitis C virus (HCV) infection and aminotransferase abnormalities as well as histological changes in the liver associated with HCV infection. Of the eligible 3,707 inhabitants aged 6 years and older in an HCV infection epidemic area 2,382 (64.3%) were examined. The anti-HCV positivity rate was 20.7% on average and increased according to age. Age was the most potential risk indicator for anti-HCV positivity by multiple stepwise regression analysis. The HCV RNA positivity rate in females with anti-HCV was significantly lower than that in males. However, as the age of females increased, the HCV RNA positivity rate became higher. The proportion of subjects with aminotransferase abnormalities among HCV RNA-positive subjects was significantly lower in females than males. Aminotransferase abnormalities significantly increased with age in females. In subjects with abnormal aminotransferase levels, nearly half of the HCV RNA-positive females were aged 50 or older and also nearly half of the male subjects showed CAH2B or liver cirrhosis, while most of the HCV RNA-positive females younger than 50 exhibited histological findings consistent with CPH. In conclusion, age was the principal risk indicator for HCV infection in this area. Females, especially those younger than 50, both biochemically and histologically showed less severity of HCV infection than males. Gender and age might have effects on the outcome of HCV related liver disease.
Article: Long-term insured lives morbidity and mortality risk associated with chronic hepatitis C virus infection.[show abstract] [hide abstract]
ABSTRACT: Hepatitis C virus (HCV) infects 170 million people worldwide. Some medical experts have suggested that progression to end-stage liver disease is inevitable; others have concluded that progression is restricted to a limited percentage of those who are infected. These opposing views have added to the uncertainty faced by underwriters who must assess risk in applicants infected with HCV. This article discusses use of a Markov model to estimate risk associated with chronic HCV infection in otherwise healthy applicants for life and critical illness insurance. Estimated mortality ratios varied with assumptions regarding rate of progression from active HCV infection to cirrhosis. For males, peak mortality ratios decreased with advancing age at underwriting from a high of 209% (age 20) to a low of 122% (age 60). A similar age-related pattern was seen for females, from a peak mortality ratio of 184% (age 20) to a low of 128% (age 60). In contrast to the pattern of decreasing relative mortality at older ages, morbidity increased with age at underwriting. Sensitivity analysis indicated that calculations in the model were sensitive to different transition rates from active HCV infection to cirrhosis and from cirrhosis to hepatocellular carcinoma (HCC) but not sensitive to treatment frequency and success. A review of the literature also suggested that a favorable prognosis was likely in applicants with persistently normal alanine aminotransferase (ALT) levels, but prognosis was less certain for those with intermittent or persistent elevation of liver enzymes. Morbidity and mortality are within the insurable range for the majority of HCV-infected persons. Risk varies with gender, age at infection, and other variables discussed in the article.Journal of insurance medicine (New York, N.Y.) 02/2000; 32(4):226-48.