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 drinking habits.

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 men.

"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 approaches."

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.