Heavy-Drinking Women with HCV Infection Cut Decade Off Life
ARLINGTON, Va., Jan. 25 -- Women with hepatitis C viral infections who drink
heavily squander their normal survival advantage over men with the same
infections, investigators here found.
Heavy-drinking HCV-infected women died more than a decade earlier than
HCV-infected women who drank only moderately or not at all, reported Chiung
M. Chen, M.A., and colleagues, in the February issue of Alcoholism: Clinical
and Experimental Research.
The findings suggest that alcohol affects men and women with HCV
differently, and provides further evidence that heavy drinking contributes
to HCV-related disease progression and death, the investigators said.
"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 Chen, an analyst at the research firm CSR, Inc. based
here. "Even fewer studies were able to examine the effect of alcohol on HCV
mortality. Our study provides empirical evidence to fill the gap."
Under contract from the National Institute on Alcohol Abuse and Alcoholism,
Chen and colleagues conducted a retrospective study of the relationship
between drinking habits and mortality in men and women infected with HCV,
using population-based mortality data.
They looked at 7,263,163 U.S. death records from 2000 to 2002, from a
National Center for Health Statistics data set. They used ICD-10 codes to
identify people who were infected with HCV and who were heavy alcohol users.
Alcohol use was determined by alcohol-induced medical conditions as either
the underlying cause or as one of the contributing causes of death.
They divided the deaths into HCV with and without heavy alcohol use, heavy
alcohol use without HCV, and all others, and used life tables to compare the
mean ages and cumulative probabilities of deaths across the categories.
They found that among those with HCV listed as the underlying or
contributing cause of death, there was an excess of heavy alcohol use
compared with those who died from non-HCV causes.
In addition, people who died from HCV-related causes and who were heavy
alcohol users tended to die sooner than HCV-infected people with temperate
Among men with HCV, the mean age at death for heavy alcohol users was 50,
compared with 55.1 for non-heavy users. For women with HCV, heavy alcohol
users died at an average age of 49.1 years, compared with 61 years for those
who were abstemious or did not drink to excess.
The cumulative probability of death before age 65 was much higher for the
HCV-infected heavy alcohol users than non-users, at 0.91 versus 0.68 for men
and 0.88 versus 0.47 for women, respectively.
"While HCV alone showed a disproportionate effect on premature death in
males, heavy alcohol use presented a stronger effect in females, resulting
in a 'catching-up' effect that diminished the gender difference in age of
HCV death," the investigators wrote.
Alex DeLuca, M.D., former chief and medical director of the Smithers
Addiction Treatment and Research Center in New York, who was not involved in
the study, commented that the research confirms earlier findings that HCV
disease progression is generally slower in women than in men, and that heavy
drinking exacts a higher price in terms of morbidity and mortality than in
"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," Dr. DeLuca
said. "I think the most important findings are the ones that confirm our
general understanding from clinical experience and other research
The authors noted several limitations to the study:
Because of the lack of information on the onset
of the HCV infection, the analysis assumed that the age of HCV infection was
similarly distributed between the ''HCV plus heavy alcohol use'' and ''HCV
without heavy alcohol use'' categories. Under this assumption, the mean age
at death was used to reflect the duration of disease progression of the two
categories. If the onset of HCV infection was at younger ages among heavy
drinkers than nonheavy drinkers, the observed alcohol effect for the ''HCV
plus heavy alcohol use'' category may be overestimated.
Because drinking history is not provided in
death certificates, it is impossible to establish the dose-response
relationship between level of alcohol consumption and premature HCV deaths.
The alcohol-induced medical conditions coded on death certificates reflect
heavy, problematic drinking. Therefore, this study was not able to assess
the effect of light and moderate alcohol consumption.
Using alcohol-induced medical conditions as a proxy for heavy drinking may
underidentify heavy drinkers because not all heavy drinkers develop these
medical conditions, and alcohol-induced medical conditions are generally
under-reported on death certificates.
The study was conducted for the Alcohol Epidemiologic Data System (AEDS)
under from the National Institute on Alcohol Abuse and Alcoholism. The
authors had no financial disclosures. CSR, Inc. is a private company selling
contract and research services.
Primary source: Alcoholism: Clinical and Experimental Research
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.