Peri‐complication diagnosis of hepatitis C infection: risk factors and trends over time

Background and Aims — Hepatitis C virus (HCV) is a common and treatable cause of cirrhosis and its complications, yet many chronically infected individuals remain undiagnosed until a late stage. We sought to identify the frequency of and risk factors for HCV diagnosis peri‐complication, that is within six months of an advanced liver disease complication.

Methods — This was a retrospective cohort study of Ontario residents diagnosed with chronic HCV infection between 2003 and 2014. HCV diagnosis peri‐complication was defined as the occurrence of decompensated cirrhosis, hepatocellular carcinoma, or liver transplant within +/‐ 6 months of HCV diagnosis. Multivariable logistic regression was used to identify risk factors for peri‐complication diagnosis among all those diagnosed with HCV infection.

Results — Our cohort included 39,515 patients with chronic HCV infection, of whom 4.2% (n=1,645) were diagnosed peri‐complication; these represented 31.6% of the 5,202 patients who developed complications in the follow‐up period. Peri‐complication diagnosis became more common over the study period and was associated with increasing age among baby boomers, alcohol use, diabetes mellitus, chronic HBV co‐infection, and moderate to high levels of morbidity. Female sex, immigrant status, having more previous outpatient physician visits, a previous emergency department visit, a history of drug use or mental health visits were associated with reduced risk of peri‐complication diagnosis.

Conclusions — Over a quarter of HCV‐infected patients with complications were diagnosed peri‐complication. This problem increased over time, suggesting a need to further expand HCV screening.