Cofactors associated with liver disease mortality in an HBsAg‐positive Mediterranean cohort: 20 years of follow‐up
Open Access
- 8 May 2006
- journal article
- research article
- Published by Wiley in International Journal of Cancer
- Vol. 119 (3), 687-694
- https://doi.org/10.1002/ijc.21882
Abstract
The risk of developing liver cancer in hepatitis B virus (HBV) carriers differs across geographical areas, suggesting that exposure to other risk factors may contribute to HBV-linked cancer risk. Our study estimates the mortality due to liver disease and the role of other risk factors in a Spanish HBV cohort. 2,352 hepatitis B surface antigen (HBsAg)-positive and 15,504 HBsAg-negative subjects were identified among blood donors during 1972–1985 and were followed until December 2000 through the Mortality Registry. Clinical examination and an epidemiological questionnaire were performed on 1,000 HBsAg-positive survivors during 1994–1996. In subjects deceased from liver disease, medical records were revised and relatives were interviewed. A nested case-control analysis was conducted comparing both groups. In HBsAg-positive men, an excess mortality from liver cancer [standardized mortality ratio (SMR): 14.1; 7.7–23.6], cirrhosis (SMR: 10.5; 7.0–15.1), haematological neoplasms (SMR: 3.2; 1.2–6.9) and AIDS was detected (SMR: 5.5; 2.2–11.4). In women, an excess was found for cirrhosis (SMR: 7.2; 1.4–21.1). Progression factors to liver disease were alcohol intake [odds ratio (OR): 6.3; 3.1–12.8], diabetes (OR: 3.6; 1.3–9.6), HBV replication (OR: 50.0; 14.9–167.3) and hepatitis C virus (HCV) infection (OR: 27.4; 7.1–107.7). In conclusion, in Spain after 20 years of follow-up, chronic HBV exposure appears as a major risk factor for liver cancer among men and for cirrhosis in both sexes. The risk of death from liver disease among HBV carriers with the presence of HBV replication, HCV, alcohol consumption and diabetes was significantly increased and suggests synergism among these exposures and HBV. Mortality from haematological neoplasms was detected and could be associated to HIV coinfection. These results support screening and adequate follow-up among HBsAg-positive subjects at high risk to develop liver disease, particularly when these risk cofactors are present.Keywords
This publication has 47 references indexed in Scilit:
- Alcohol, tobacco and obesity are synergistic risk factors for hepatocellular carcinomaJournal of Hepatology, 2005
- Hepatitis B Virus Infection and B‐Cell Non‐Hodgkin's Lymphoma in a Hepatitis B Endemic Area: A Case‐control StudyJapanese Journal of Cancer Research, 2002
- Screening for hepatocellular carcinoma in chronic carriers of hepatitis B virus: Incidence and prevalence of hepatocellular carcinoma in a North American urban populationHepatology, 1995
- Evidence for hepatitis B virus infection in patients with chronic hepatitis C with and without serological markers of hepatitis BDigestive Diseases and Sciences, 1995
- Alcohol consumption as A risk factor for hepatocellular carcinoma in urban Southern African blacksInternational Journal of Cancer, 1992
- Effects of hepatitis B virus, alcohol drinking, cigarette smoking and familial tendency on hepatocellular carcinomaHepatology, 1991
- Relative risks of death due to liver disease among Japanese male adults having various statuses for hepatitis B s and e antigen/antibody in serum: A prospective studyHepatology, 1988
- Hepatocellular carcinoma among HBsAg positive blood donors in Fukuoka, JapanEuropean Journal of Cancer and Clinical Oncology, 1988
- Long-term follow-up study of asymptomatic hbsag-positive voluntary blood donors in austria: A clinical and histologic evaluation of 242 casesHepatology, 1987
- MORTALITY OF HEPATITIS B POSITIVE BLOOD DONORS IN ENGLAND AND WALESThe Lancet, 1985