Geographical variation in hepatitis C-related severe liver disease and patient risk factors: a multicentre cross-sectional study

Despite promising steps towards the elimination of hepatitis C virus (HCV) in the UK, several indicators provide a cause for concern for future disease burden. We aimed to improve understanding of geographical variation in HCV-related severe liver disease and historic risk factor prevalence among clinic attendees in England and Scotland. We used metadata from 3829 HCV-positive patients consecutively enrolled into HCV Research UK from 48 hospital centres in England and Scotland during 2012–2014. Employing mixed-effects statistical modelling, several independent risk factors were identified: age 46–59 y (OR(adj) 3.06) and ≥60 y (OR(adj) 5.64) relative to <46 y, male relative to female sex (OR(adj) 1.58), high BMI (OR(adj) 1.73) and obesity (OR(adj) 2.81) relative to normal BMI, diabetes relative to no diabetes (OR(adj) 2.75), infection with HCV genotype (GT)-3 relative to GT-1 (OR(adj) 1.75), route of infection through blood products relative to injecting drug use (OR(adj) 1.40), and lower odds were associated with black ethnicity (OR(adj) 0.31) relative to white ethnicity. A small proportion of unexplained variation was attributed to differences between hospital centres and local health authorities. Our study provides a baseline measure of historic risk factor prevalence and potential geographical variation in healthcare provision, to support ongoing monitoring of HCV-related disease burden and the design of risk prevention measures.