Estimating the Fraction of Hepatocellular Carcinoma and Decompensated Cirrhosis Attributable to Viral Hepatitis in England Using Electronic Health Records and Case-Notes Review.

Viral hepatitis mortality is an impact target required to evidence the elimination of viral hepatitis with a combined mortality rate of less than or equal to six deaths per 100,000 population. Within England, routine healthcare data linked with death registrations are used; however, where these data are not available, the World Health Organization (WHO) recommends overlaying the attributable fraction (AF) over the mortality envelope for decompensated cirrhosis (DC) and hepatocellular carcinoma (HCC). We aimed to estimate viral hepatitis mortality using the attributable fraction and compared it to surveillance methods. Six acute NHS trusts participated across England and reviewed the case records of individuals identified retrospectively up to 31 December 2023 through hospital episode statistics to confirm the diagnosis and complete a proforma on possible exposures and likely cause of DC/HCC. Overall, 563 individuals were identified, 390 for DC review with 127 (32.6%) confirmed and 173 for HCC review with 157 (91.8%) confirmed. The AF for DC was 0.008 for HCV and 0.016 for HBV, equivalent to a crude mortality rate of 0.09 per 100,000 population and 0.17 per 100,000 population, respectively. For HCC 0.1806 for HCV and 0.0645 for HBV, equivalent to 0.85 per 100,000 population and 0.30 per 100,000 population respectively. These results are comparable to applying the attributable fraction methodology to linking healthcare data sets and demonstrate that England continues to meet the WHO impact target.