Hepatitis C virus is the leading cause of liver cancer, with the number of deaths from liver cancer more than doubling since 1979. Although lifesaving drugs became available around 1998 to treat hepatitis C, they were expensive, which limited access for some patients.1

Historically, other expensive lifesavings drugs, such as active antiretroviral drug therapy for human immunodeficiency virus (HIV), and surfactant for respiratory distress syndrome (RDS), have faced similar issues in regard to prohibitive costs limiting access, leading to racial inequalities in mortality.1

Researchers from Florida Atlantic University's Schmidt College of Medicine and Baylor College of Medicine explored this issue further in relation to liver cancer in order to investigate racial inequalities in mortality from liver cancer before and after the introduction of the lifesaving drugs for hepatitis C virus that became available around 1998 in the United States.1

The results of the study showed that racial inequalities in mortality from liver cancer in the United States were declining from 1979 to 1998. Following the release of the drug in 1998, racial inequalities in mortality began to steadily increase. Between 1998 and 2016, the excess in mortality relative to whites increased in blacks from 27.8% to 45.4%, with a predominance of mortality being among men. The results also showed that, during this time, the racial inequalities in mortality decreased for major risk factors associated with liver cancer, such as alcohol, obesity and diabetes.1

Furthermore, the rate among blacks increased from 9.4 per 100,000 in 1998 to 16.7 per 100,000 in 2016, which is an increase of 77.7%. The corresponding values for whites were 7.2 to 10.3, which is an increase of 43.1%.1

In the 55 years and older age group among blacks, a population that suffers the largest disease burden, the mortality rate increased by 1.7% per year from 1979 to 1997, and by 4.2% per year from 2000 to 2016. Yet, the corresponding rates among whites increased by 3.5% per year from 1979 to 1990, and then increased by 2% per year from 1990 to 2016.1

“We observed steady increases in racial inequalities in mortality from liver cancer after the licensure of lifesaving drugs for hepatitis C virus in the United States,” said Charles H. Hennekens, MD, PhD, senior author of the study, the first Sir Richard Doll Professor and senior academic advisor in FAU's Schmidt College of Medicine, and an adjunct professor at Baylor College of Medicine, in a press release.2

According to the authors, the descriptive data from the study are useful for forming, but not for testing, hypotheses. They added that some potential hypotheses for the racial inequalities in mortality after 1998 include social adverse effects, including unequal accessibility, acceptability and/or utilization of health care resources.1

“A major clinical and public health priority should be to decrease racial inequalities in mortality following the introduction of lifesaving drugs in the United States and worldwide,” Hennekens said in a press release.2

In the United States, more than 3 million people are affected by liver cancer, with about 17,000 new cases every year. Currently, Hepatitis C virus has caused approximately 30,160 deaths (20,020 in men and 10,140 in women) in the past year. For men, liver cancer is the 5th most common cause of cancer deaths, and for women, it is the 7th.2


REFERENCES
 
  1. Levine RS, Mejia MC, Salemi JL, et al. A descriptive study of racial inequalities in mortality from hepatocellular cancer before and after licensure of lifesaving drugs for hepatitis C virus in the United States. EClinicalMedicine. 2020;22(2020):100350. doi: 10.1016/j.eclinm.2020.100350.
  2. Racial inequalities in liver cancer deaths soared after launch of hepatitis C drugs [news release]. Eurekalert. Florida Atlantic University; April 30, 2020. new.eurekalert.org/pub_releases/2020-04/fau-rii043020.php. Accessed May 4, 2020.