In resource‐rich countries, chronic hepatitis C (CHC) infection is associated with a sizeable excess mortality risk. The extent to which this is due to (1) the biological sequelae of CHC infection versus (2) a high concomitant burden of health risk behaviors (HRBs) is unclear. We used data from the 1999‐2010 U.S. National Health and Nutritional Examination Surveys (NHANES), which include detailed information on HRBs and CHC infection status. We calculated the prevalence of the five major HRBs—alcohol use; cigarette smoking, physical inactivity, unhealthy diet, and illicit drug use—according to CHC after adjusting for sociodemographic differences. Mortality status after survey interview was ascertained by linkage to the U.S. National Death Index. To assess the contribution of HRBs to the excess mortality risk, we determined the all‐cause mortality rate ratio (MRR) for individuals with CHC relative to individuals without, and then calculated the attenuation in this MRR following adjustment for HRBs. This analysis included 27,468 adult participants of NHANES of which 363 tested positive for CHC. All HRBs were markedly more prevalent among individuals with CHC versus individuals without. CHC was associated with a 2.4‐fold higher mortality rate after adjustment for sociodemographic factors (MRR, 2.36; 95% CI, 1.60‐3.49). Subsequent adjustment for all five HRBs attenuated this ratio by 50.7% to MRR 1.67 (95% CI, 1.14‐2.44). Higher levels of attenuation (69.1%) were observed among individuals aged 45‐70 years, who form the target demographic for U.S. birth cohort screening. Conclusion: At least half the excess mortality risk for individuals with CHC in the United States may be attributed to HRBs rather than CHC. The remedial response to hepatitis C must not neglect action on HRBs if it is to fully resolve the high mortality problem in this population. (Hepatology 2018;67:97‐107).

中文翻译：

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健康风险行为对美国慢性丙型肝炎成人高死亡率的贡献：一项人群队列研究

在资源丰富的国家，慢性丙型肝炎 (CHC) 感染与相当大的超额死亡风险相关。这在多大程度上是由于 (1) CHC 感染的生物学后遗症与 (2) 伴随的高健康风险行为 (HRB) 负担尚不清楚。我们使用了 1999-2010 年美国国家健康和营养检查调查 (NHANES) 的数据，其中包括有关 HRB 和 CHC 感染状态的详细信息。我们计算了五种主要 HRB 的流行率——酒精使用；吸烟、缺乏身体活动、不健康饮食和非法药物使用——根据社会人口统计学差异调整后的 CHC。调查访谈后的死亡率状况通过与美国国家死亡指数的联系来确定。为了评估 HRB 对过度死亡风险的贡献，我们确定了 CHC 个体相对于非 CHC 个体的全因死亡率比 (MRR)，然后计算了调整 HRB 后该 MRR 的衰减。该分析包括 NHANES 的 27,468 名成年参与者，其中 363 人的 CHC 检测呈阳性。与没有 CHC 的个体相比，所有 HRB 在患有 CHC 的个体中更为普遍。在调整社会人口因素后，CHC 与高 2.4 倍的死亡率相关（MRR，2.36；95% CI，1.60-3.49）。随后对所有五个 HRB 进行调整后，该比率降低了 50.7% 至 MRR 1.67（95% CI，1.14-2.44）。在 45-70 岁的人群中观察到更高水平的衰减 (69.1%)，他们构成了美国出生队列筛查的目标人群。结论：在美国，CHC 患者的超额死亡风险至少有一半可能归因于 HRB 而不是 CHC。如果要完全解决这一人群的高死亡率问题，那么对丙型肝炎的补救措施就不能忽视对 HRB 的行动。（肝病学 2018 年；67：97-107）。