Review Article

Hepatitis C Virus Infection and Hospital-Related Outcomes: A Systematic Review

Table 2

Summary of included studies.

Author (year)Study period/study locationDatabase/studyN/populationAge/% male/ethnicityHIV positive (%)Substance use (%)

Prospective cohort studies
Gardner et al., 2003 [21]1993–2000/USHIV Epidemiology Research StudyN = 885/women aged 16–55 years with HIV infectionAge: ≤30 years 21.4%, 31–44 years 68.4%/male 0%/African American 60.8%, White 20.7%, Hispanic 17.2%, and other 1.4%100%60.7%
Gebo et al., 2003 [22]1995–2000/USN = 3730/patients with HIV infectionMean age: 37.2 years (range 17–82)/male 67.5%/White 21.5%, African American 76.9%, and other 1.5%100%47.4%
Goodkin et al., 2017 [23]1996–2015/Australia, Belgium, Canada, China, France, Germany, Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, United Arab Emirates, Italy, Japan, New Zealand, Spain, Russia, Sweden, Turkey, UK, and USDialysis Outcomes and Practice Patterns StudyN = 76689/age ≥18 years on hemodialysisMean age: 62.5 years/male 58.7%/Black 28.4%†0.8%2% in the last 12 months
Linas et al., 2011 [24]2000–2007/USACTG Longitudinal Linked Randomized Trials (ALLRT)N = 3143/patients with HIV infectionMean age: 40 years (SD 9.2)/male 83.3%/White 50.2%, African American 27.8%, Hispanic 19.2%, and other 2.7%100%9.7%
Mena et al., 2017 [25] ‡1993–2014/Spain--(University Hospital of A Coruna, Spain)N = 2379/people with HIV infectionMean age: 32.2 years at HIV diagnosis/male 75.2%/ethnicity NR100%48.8%
Rezk & Omar, 2017 [26]2012–2017/EgyptN = 512/pregnant womenAge: 20–30 years 61.7%, >30 years 38.3%/male 0%/ethnicity NRNR0%
Shankar et al., 2011 [27]2007–2011/CanadaN = 208/age ≥18 years undergoing primary liver transplantationMean age: 53.1 years (SD 9.8)/male 78.8%/ethnicity NRNRNR
Tandon et al., 2015 [28]2001–2011/USOptumHealth Reporting and Insights DatabaseN = 19682/age ≥18 years with private insuranceMean age: 52.0 years/male 61.4%/ethnicity NRExcluded4.0%
Teshale et al., 2016 [29]2006–2013/USChronic Hepatitis Cohort StudyN = 30393/age ≥18 yearsAge: 46–60 years 69.2%/male 59.2%/White 63.1%, Black 23.7%, Hispanic 3.9%, Asian 3.3%, Hawaiian/Pacific Islander 1.4%, American Indian/Alaska Native 1.4%, and unknown 3.2%ExcludedNR
Tsui et al., 2009 [30]2000–2002/USHeart and Soul StudyN = 981/outpatients with coronary heart diseaseMean age: 66.3 years/male 81.9%/non-White 39.7%2.5%7.6%

Retrospective cohort studies
Alvaro-Meca et al., 2016 [31]2005–2010/SpainSpanish minimum basic data setN = 5265/age ≥19 years with cirrhosis admitted to ICUMedian age: chronic hepatitis C 58.2 years, control 57.2/male 65.6%/ethnicity NRExcluded37.3% alcohol and drug abuse
Ananthakrishnan et al., 2010 [32] §2006/USNationwide inpatient sampleN = 263062/hospitalized patients with HIV and/or HCV infectionAge for coinfected group: 36–50 years 55.7%, 51–65 years 33.3%/male 63.4%/White 38.2%, Black 26.6%, Hispanic 13.0%, other 3.2%, and missing 19.0%35.6%NR
Baran et al., 2018 [33]2005–2016/TurkeyTurcoSCORE databaseN = 120/patients undergoing cardiac surgeryMean age: 61.1 years/male 50.8%/ethnicity NRNRNR
Batty et al., 2001 [34]1994–1997/USUS renal data systemN = 28692/renal transplant recipientsMean age: 43.0 years/male 60.4%/ethnicity inconsistent dataNRInconsistent data
Best et al., 2015 [35]1990–2007/USNational hospital discharge surveyN = 8363266/noncirrhotic patients admitted for primary THA or TKAMean age: 67.3 years/male 38.5%/ethnicity NRExcludedNR
Camargo et al., 2019 [36]2007–2017/USN = 13 (7 DAA, 6 pre-DAA)/Coinfected HIV/HCV kidney transplant recipientsMedian age: 56 years (IQR 47–63)/male 84.6%/African American 76.9%100%NR
Chen et al., 2002 [37]1992–1998/TaiwanN = 252/patients who underwent hepatic resection for hepatocellular carcinomaMean age: 54.3 years (range 19–87)/male 77.8%/ethnicity NRNRNR
Cholankeril et al., 2016 [38]2003–2012/USNationwide inpatient sampleN = 1217165/adults hospitalized with HCV or HBVMean age: 51.4 years/male 62.3%/White 48.4%, Black 4.8%, Hispanic 11.4%, Asian 2.3%, and other 3.4%AIDS 3.6%23.4%
Chowdhury et al., 2017 [39]2006–2014/USTricare insurance claims (from Military Data Repository)N = 2262/age 18–64 years who received major orthopaedic surgery (spine, THA, and TKA)Mean age: 52.6 years (SD 8.7)/male 51.5%/White 51.7%NRNR
Crowell et al., 2014 [40]2010/USHIV research networkN = 12819/adults with HIV infectionMedian age: 47 years (IQR 40–53)/male 71.7%/White 26.7%, Black 49.2%, Hispanic 20.8%, and other/unknown 3.4%100%17.4%
Crowell et al., 2015 [41]2006–2011/USHIV research networkN = 15927/adults with HIV infectionMedian age: HIV mono-infection 40.4 years (IQR 32.6–47.0), HIV/HCV coinfection 47.0 years (42.0–51.9)/male 76.8%/White 35.7%, Black 43.5%, Hispanic 17.7%, and other/unknown 3.1%100%16.7%
Dai et al., 2019 [42]2012–2015/ChinaN = 3402/age ≥18 years admitted with cirrhosisAge: 40–59 years 60.4%, ≥60 years 21.6%/male 71.3%/Han 73.6%, and minority 26.4%ExcludedNR
Davis et al., 2011 [43]2002–2006/USIntegrated Health Care Information Services (IHCIS) Managed Care Benchmark DatabaseN = 41324/patients enrolled in the US claims database with no HBV diagnoses, ≥6 and ≥12 months of continuous plan enrollment pre- and postdiagnosis of chronic HCVMean age: 48.9 years/male 60.7%/ethnicity NRNRNR
Deshpande et al., 2019 [44]2005–2016/USMedicareN = 291663/patients with HCV infection receiving hemodialysisMean age: 67.3 years (SD 15.2)/male 55.0%/White 55.0%, Black 32.5%, Asian 3.0%, Hispanic 5.8%, and Native American 1.4%NRNR
Duberg et al., 2011 [45]1990–2006/SwedenSwedish Institute for Infectious Disease Control—National Surveillance DatabaseN = 258000/individuals diagnosed with HCV infection, compared to the general populationMean age: 38.3 years (SD 12.8)/male 69.1%/Country of origin: Nordic 89.3%, non-Nordic European 4.9%, Asia 3.4%, Africa 1.1%, South America 0.8%, and North America 0.4%NR9.6% in HCV group
Falster et al., 2010 [46]1999–2007/AustraliaAustralian HIV Observational DatabaseN = 842/patients with HIV infectionMedian age: 41 years (IQR 35–48)/male 94.4%/ethnicity NR100%NR
Fukui et al., 2017 [47]2010–2014/USMedicareN = 37165/hospitalized patients age ≥65 years or with qualified health conditions discharged to hospiceMean age: 82.3 years/male 40.4%/White 87.2%, Black 8.3%NRNR
Gidding et al., 2010 [48]1992–2006/AustraliaNew South Wales Notifiable Diseases DatabaseN = 82601 (HCV only)/people notified of HCV mono-infection, compared to the general population of New South WalesFor the HCV group only,median age 37 years (IQR 29–44)/male 63.0%/ethnicity NRExcludedHospitalization rate 29.0/1000 person-years for illicit drug use
Grau et al., 2018 [49]1990–2007/USNational Hospital Discharge SurveyN = 4717536/noncirrhotic patients hospitalized with surgically treated hip fracturesMean age: 79 years/male 26.1%/ethnicity NRExcludedNR
Hill et al., 2018 [50]2011–2017/USN = 378 (196 DAA, 182 untreated)/age ≥18 years with chronic active HCV with cirrhosisMedian age: DAA 59 years (range 18–82), untreated 56 years (range 35–74)/male 61.1%/White 56.3%, Black 11.4%, Asian 3.4%, other 26.7%, and unknown 2.1%6.3%NR
Issa et al., 2015 [51] #1998–2010/USNationwide Inpatient SampleN = 25372/patients who underwent primary THA or TKAMean age: 66.4 years/male 39.0%/White 86%, and non-White 14%NRNR
Kim et al., 2001 [52]1995/USHealthcare Cost and Utilization Project DatabaseN = 283000/hospitalizations related to liver disease from HCV infection or alcoholMedian age: HCV/ETOH 43 years, ALD 51 years/male 69.6%/ethnicity NR3.1%NR
King et al., 2016 [53]1999–2011/USUS Renal Data System, MedicareN = 3643/adult primary first-time simultaneous pancreas-kidney recipientsMean age: 40.1 years/male 64.2%/African American 20.6%NRNR
Lee et al., 2019 [54]2005–2008/TaiwanTaiwan National Health Insurance Research DatabaseN = 115336/age ≥20 years without cirrhosis participating in the New Taipei City Health ScreeningMean age: 52.2 years/male 35.6%/ethnicity NR0%0%
Mahure et al., 2018 [55]2010–2014/USNew York Statewide Planning and Research Cooperative System (SPARCS) DatabaseN = 80722/age ≥18 years undergoing elective inpatient THAMean age: 65 years/male 44.7%/White 80.7%, Black 7.8%, Hispanic 3.8%, and other 7.7%0.8%1.1%
Marrie et al., 2017 [56]2000–2014/CanadaProvincial Lab for Public Health (Edmonton, Alberta)N = 3251/age ≥17 years with invasive pneumococcal diseaseMean age: 54.6 years/male 56.5%/aboriginal 13.8%4.2%17.2%
McCombs et al., 2011 [57]2003–2008/USUnknown Health Insurance CompanyN = 17722/commercially insured patientsMean age: 49.6 years/male 60.1%/ethnicity NRExcludedNR
McDonald et al., 2019 [58]2013–2018/ScotlandHCV Clinical DatabaseN = 1073/patients with chronic HCV infection and compensated cirrhosis, initiated on IFN-free DAAAge: 45–54 years 42.4%/male 74.6%/ethnicity NRNR62.6% PWID
Medrano et al., 2014 [59]2005–2010/SpainSpanish Minimum Basic Data SetN = 1891/age ≥19 years with HIV infection admitted to ICUMedian age: 43 years/male 77.5%/ethnicity NR100%49.8% alcohol and drug abuse
Meijide et al., 2017 [60]1993–2013/Spain-University Hospital of A Coruna, SpainN = 1937/hospitalized patients with HIV infectionMean age: 36.4 years (SD 10.6)/male 75.0%/ethnicity NR100%NR
Myers et al., 2009 [61]1993–2005/USNationwide Inpatient SampleN = 581380 hospitalizations/age ≥18 years hospitalized with cirrhosisMean age: 57.0 years/male 60.8%/White 54%, African American 8.7%, Hispanic 12.4%, Asian/Pacific Islander 1.4%, and other 23.5%0.9%5.0%
Norton et al., 2012 [62]1996–2010/USN = 261/age ≥18 years with HIV-1 mono-infectionMedian age: 50 years/male 75.9%/White 40.6%, Black 54.4%, and other 5.0%100%18.0%
Patel et al., 2016 [63]2005–2015/USUNOS Standard Transplant Analysis and Research RegistryN = 325/age ≥19 years who underwent deceased donor liver transplantationMean age: 55.9 years (SD 8.8)/male 78.7%/Black 7.1%, Hispanic 4.6%, other 4.0%, and White 84.3%NRNR
Rentsch et al., 2019 [64]1997–2014/USVeterans Aging Cohort Study (Veterans Health Administration), MedicareN = 155550/patients in the veterans health administration with and without HIV, HCV, and alcohol-related diagnosesMedian age: 47 years (IQR 40–54)/male 97.3%/Black 47.1%, White 39.9%, Hispanic 8.2%, and other/unknown 4.8%32.0%13.8%
Sayiner et al., 2016 [65]2005–2010/USMedicareN = 273132/patients born between 1945 and 1965Age: 50–54 years 25.5%, 55–59 years 30.5%/male 50.2%/White 72.3%, and non-White 27.7%NRNR
Schanzer et al., 2018 [66]2004–2016/CanadaCanadian Discharge Abstract DatabaseN = 2115–3255 hospitalizations per year, 331–464 inpatient deaths per year/inpatients diagnosed with chronic HCV and chronic liver diseaseNRNRNR
Sharma et al., 2017 [67]2003–2010/USScientific Registry of Transplant RecipientsN = 7220/age ≥18 years and older who underwent deceased donor liver transplantationMedian age: 59 years (IQR 52–66)/male 66.4%/White 73.9%, Black 7.6%, Asian 3.8%, Hispanic/Latino 13.6%, multiracial/other 1.1%NRNR
Singal et al., 2012 [68]1998–2007/USNationwide Inpatient SampleN = 111726/patients hospitalized with alcoholic hepatitisAge: 40–50 years 36.3%, 50–60 years 25.9%/male72.8%/Hispanic 7.8%, caucasian 52.6%, African American 11.0%, and others 28.7%NRNR
St-Jean et al., 2019 [69]2000–2015/CanadaBC Seek and Treat for Optimal Prevention of HIV/AIDSN = 4046/age ≥18 years with HIV infection and ART-naïve, initiating treatmentAge: 30–39 years 30.5%, 40–49 years 35.4%/male 81.9%/ethnicity NR100%34.4%
Steinke et al., 2002 [70]1989–1999/ScotlandEpidemiology of Liver Disease in Tayside (ELDIT) DatabaseN = 1407 (with matched control), 366849 (general population)/registrants in a liver disease database, compared to general population in tayside, scotlandMean age: HCV 34.8 years (SD 15.4), general population 42.5 years (SD 23.1)/male: HCV
68.4%, general population 48.9%/ethnicity NR
NROR 50.5 (95% CI 16.1–159.1) for methadone treatment in HCV group
Thuluvath et al., 2013 [71]1998–2006/USNationwide inpatient sampleN = 112351/noncirrhotic patients hospitalized with alcoholic hepatitisMean age: 46.5 years/male 67.5%/ethnicity NRNRNR
Tsui et al., 2006 [72]1996–2002/USN = 6532/patients hospitalized with alcohol dependence or abuseMean age: 46.8 years/male 80.7%/White 41.0%, Black 33.1%, Hispanic 18.1%, Asian 3.2%, and unknown/other 4.7%NRNR
Wei et al., 2018 [73]2009–2011/USHealthcare Cost and Utilization Project State Inpatient Database, CaliforniaN = 69612/age ≥18 years hospitalized with cirrhosisMean age: 59.4 years/male 61.9%/Caucasian 69.4%, African American 6.9%, Hispanic 0.7%, Asian/Pacific Islander 6.4%, Native American 15.8%, and other 0.7%NRNR
Wurcel et al., 2018 [74]2004–2014/USN = 4673/hospitalized inmates age ≥18 yearsMedian age: 44 years (IQR 34–52)/male 92.6%/White 53.3%, Black 21.2%, Hispanic 12.0%, other 13.5%, missing data 1.5%2.5%NR

Cross-sectional studies
Baum et al., 2008 [75]2002–2006/USN = 192/age ≥19 years with HIV infection and active drug useMean age: 42.3 years/male 74.5%/African American 78.2%, Hispanic 15.1%, White non-Hispanic 6.3%, others 0.5%100%100%
El Khoury et al., 2012 [76]2010/USUS National Health and Wellness SurveyN = 612/age ≥18 yearsMean age: 53.4 years/male 62.1%/White 72.9%, Black 12.1%, Hispanic 7.5%, and other 7.5%ExcludedNR
Vietri et al., 2013 [77]2010/France, Germany, UK, Italy, SpainEuropean National Health and Wellness SurveyN = 572/age ≥18 yearsFor HCV group only, mean age: 52.8 years (SD 13.49)/male 58.4%/ethnicity NRExcludedNR

AIDS: acquired immunodeficiency syndrome; ALD: alcohol-induced liver disease; ART: antiretroviral therapy; CI: confidence interval; DAA: direct-acting antiviral; HBV: hepatitis B virus; HCV: hepatitis C virus; HCV/ETOH: concurrent hepatitis c and alcohol abuse or alcohol-induced liver disease; HIV: human immunodeficiency virus; ICU: intensive care unit; IFN: interferon; IQR: interquartile range; NR: not reported; OR: odds ratio; PWID: people who inject drugs; SD: standard deviation; THA: total hip arthroplasty; TKA: total knee arthroplasty; US: United States; UK: United Kingdom. †Ethnicity data only available from North America, which made up 38.4% of total N. ‡Prospective and retrospective cohort study. §Analysis based on N = 263062 (HIV/HCV coinfection 56304; HIV mono-infection 206758). Demographic information based on N = 737905 including coinfection, HIV mono-infection and HCV mono-infection. ¶Data reported for ethnicity and substance use was inconsistent between percentage reported and absolute numbers reported. #Demographic information (age, sex, and ethnicity) based on N = 1700400 with HCV 0.47%.