Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2017; 23(10): 1866-1871
Published online Mar 14, 2017. doi: 10.3748/wjg.v23.i10.1866
Mortality associated with hepatitis C and hepatitis B virus infection: A nationwide study on multiple causes of death data
Ugo Fedeli, Enrico Grande, Francesco Grippo, Luisa Frova
Ugo Fedeli, Epidemiological Department, Veneto Region, 35131 Padova, Italy
Enrico Grande, Francesco Grippo, Luisa Frova, Italian National Institute of Statistics, 00184 Roma, Italy
Author contributions: All authors contributed equally to this work, designed the study, performed analyses, and wrote the manuscript.
Institutional review board statement: Mortality data are routinely collected by the National Institute of Statistics. All analyses were carried out on aggregated data without any possibility of identification of individuals; therefore, the study was exempt from institutional review board approval.
Informed consent statement: Since analyses were carried out on retrospective, routinely collected aggregated data, the informed consent was not required.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ugo Fedeli, MD, Epidemiological Department, Veneto Region, Passaggio Gaudenzio 1, 35131 Padova, Italy. ugo.fedeli@regione.veneto.it
Telephone: +39-49-8778251 Fax: +39-49-8778235
Received: November 15, 2016
Peer-review started: November 16, 2016
First decision: December 28, 2016
Revised: January 16, 2017
Accepted: February 16, 2017
Article in press: February 17, 2017
Published online: March 14, 2017

To analyze mortality associated with hepatitis C virus (HCV) and hepatitis B virus (HBV) infection in Italy.


Death certificates mentioning either HBV or HCV infection were retrieved from the Italian National Cause of Death Register for the years 2011-2013. Mortality rates and proportional mortality (percentage of deaths with mention of HCV/HBV among all registered deaths) were computed by gender and age class. The geographical variability in HCV-related mortality rates was investigated by directly age-standardized rates (European standard population). Proportional mortality for HCV and HBV among subjects aged 20-59 years was assessed in the native population and in different immigrant groups.


HCV infection was mentioned in 1.6% (n = 27730) and HBV infection in 0.2% (n = 3838) of all deaths among subjects aged ≥ 20 years. Mortality rates associated with HCV infection increased exponentially with age in both genders, with a male to female ratio close to unity among the elderly; a further peak was observed in the 50-54 year age group especially among male subjects. HCV-related mortality rates were higher in Southern Italy among elderly people (45/100000 in subjects aged 60-79 and 125/100000 in subjects aged ≥ 80 years), and in North-Western Italy among middle-aged subjects (9/100000 in the 40-59 year age group). Proportional mortality was higher among Italian citizens and North African immigrants for HCV, and among Sub-Saharan African and Asian immigrants for HBV.


Population ageing, immigration, and new therapeutic approaches are shaping the epidemiology of virus-related chronic liver disease. In spite of limits due to the incomplete reporting and misclassification of the etiology of liver disease, mortality data represent an additional source of information for surveillance.

Keywords: Hepatitis C virus, Hepatitis B virus, Mortality, Epidemiology, Immigrants

Core tip: Multiple causes of death analyses carried out on the Italian National Cause of Death Register showed that 1.6% and 0.2% of all deaths in 2011-2013 were associated with hepatitis C virus (HCV) and hepatitis B virus (HBV) infection, respectively. HCV-associated mortality followed a bimodal distribution, increasing exponentially among the elderly in both genders, with a minor peak in middle-aged subjects, especially among males. The proportion of viral hepatitis-related deaths was higher among Italian citizens and North African immigrants for HCV, and among Sub-Saharan African and Asian immigrants for HBV.