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Aliment Pharmacol Ther. 2017 Sep;46(6):605-616. doi: 10.1111/apt.14241. Epub 2017 Aug 2.

Ethnic disparities in progression to advanced liver disease and overall survival in patients with chronic hepatitis C: impact of a sustained virological response.

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Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.
Department of Cirrhosis, Institute of Liver Disease, Shuguang Hospital, Shanghai, China.
Stanford University, Palo Alto, CA, USA.
David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
Department of Epidemiology and Biostatistics, Zhejiang University, Hangzhou, China.
Department of Medicine, University of California, San Diego, San Diego, CA, USA.
Center for Clinical Informatics, Stanford University School of Medicine, Palo Alto, CA, USA.
Chinese Hospital, San Francisco, CA, USA.



Chronic hepatitis C (CHC) can lead to cirrhosis and hepatocellular carcinoma (HCC). A sustained virological response (SVR) is associated with improved outcomes, however, its impact on different ethnic groups is unknown.


To evaluate ethnic differences in the natural history of CHC and the impact of SVR.


We conducted a cohort study of 8039 consecutive adult CHC patients seen at two medical centres in California between January 1997 and June 2016. Individual chart review confirmed CHC diagnosis.


Asian and Hispanic but not African American patients had significantly higher cirrhosis and HCC incidence than Caucasians. On multivariate analysis, Hispanic ethnicity was independently associated with increased cirrhosis (adjusted HR 1.37, CI, confidence interval 1.10-1.71, P=.006) and HCC risk (adjusted HR 1.47, CI 1.13-1.92, P=.004) compared to Caucasian. Asian ethnicity had a significant association with cirrhosis (adjusted HR 1.28, CI 1.02-1.61, P=.034) and HCC risk (adjusted HR 1.29, CI 0.94-1.77, P=.025). In patients who achieved SVR, Hispanic ethnicity was no longer independently associated with cirrhosis (adjusted HR 1.76, CI 0.66-4.71, P=.26) or HCC (adjusted HR 1.05, CI 0.27-4.08, P=.94); nor was Asian ethnicity (adjusted HR 0.62, CI 0.21-1.82, P=.38 for cirrhosis; 2.01, CI 0.63-6.36, P=.24 for HCC). Similar findings were observed with overall survival among the ethnicities by SVR status.


Hispanic and Asian ethnicity was independently associated with increased cirrhosis and HCC risk. Achieving an SVR eliminates the ethnic disparity in liver disease progression and overall survival between Hispanic and Asian vs Caucasian CHC patients.

[Indexed for MEDLINE]

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