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However, the risk of early mortality after HCV cure remains. We examined factors associated with cause\u2010specific mortality after direct\u2010acting antiviral (DAA) therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>DAA\u2010treated adults (recruited 2016\u20132021) were followed up to September 2023. Medication, health\u2010service use, and deaths were obtained from population databases. The primary outcome was all\u2010cause and cause\u2010specific mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 3619 patients (average 52.0\u2009years (SD\u2009=\u200910.5), 66.0% male, 33.6% with cirrhosis) followed for a median of 6.8\u2009years (IQR 5.5\u20137.4), 423 (11.7%) died (40.6% due to liver disease, 13.2% self\u2010harm\/accidental poisoning and 12.3% respiratory disease\/lung cancer). Cirrhosis (adjusted hazard ratio (adj\u2010HR)\u2009=\u200914.51, 95% CI 6.87\u201330.64), FIB4\u2009&gt;\u20093.25 (adj\u2010HR\u2009=\u20094.22, 95% CI 2.63\u20136.80), nonsustained virological response (SVR) (adj\u2010HR\u2009=\u20093.94, 95% CI 2.64\u20135.88) and age\u2009\u2265\u200960\u2009years (adj\u2010HR\u2009=\u20091.88, 95% CI 1.32\u20132.69) increased <jats:italic>liver\u2010related mortality<\/jats:italic> risk. Mortality was threefold higher in non\u2010SVR (32.4% of 210 patients vs. 10.2% of 2894 with SVR, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Non\u2010SVR increased risk of liver mortality (adj\u2010HR\u2009=\u20094.30, 95% CI 2.90\u20136.37). Mental health medication use (adj\u2010HR\u2009=\u20092.82, 95% CI 1.40\u20135.67), loss to clinical follow\u2010up (adj\u2010HR\u2009=\u20092.61, 95% CI 1.31\u20135.21) and injection drug use\/opioid replacement therapy (adj\u2010HR\u2009=\u20092.26, 95% CI 1.23\u20134.14) increased risk of <jats:italic>self\u2010harm\/accidental poisoning<\/jats:italic>\u2010related mortality<jats:italic>.<\/jats:italic> Age\u2009\u2265\u200960\u2009years and diabetes increased mortality risk from <jats:italic>other extrahepatic cancer<\/jats:italic> (adj\u2010HR\u2009=\u20092.68, 95% CI 1.31\u20135.51 and adj\u2010HR\u2009=\u20092.57, 95% CI 1.15\u20135.72) and <jats:italic>cardiovascular disease<\/jats:italic> (adj\u2010HR\u2009=\u20092.71, 95% CI 1.06\u20134.19 and adj\u2010HR\u2009=\u20092.28, 95% CI 1.03\u20135.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Liver\u2010related death drives mortality for cirrhotic patients. Curing HCV remains critical. Holistic HCV care, with attention to mental health illnesses in younger patients, metabolic comorbidities, and better cancer screening for older patients may reduce excess mortality.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.70219","type":"journal-article","created":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T07:14:07Z","timestamp":1750317247000},"page":"602-619","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Surviving Hepatitis C\u2014Understanding Death and Survival Beyond Cure"],"prefix":"10.1111","volume":"62","author":[{"given":"Paul J.","family":"Clark","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Princess Alexandra and Mater Hospitals, and Faculty of Medicine The University of Queensland  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8823-3006","authenticated-orcid":false,"given":"Patricia C.","family":"Valery","sequence":"additional","affiliation":[{"name":"QIMR Berghofer Medical Research Institute, and Faculty of Medicine The University of Queensland  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone I.","family":"Strasser","sequence":"additional","affiliation":[{"name":"Morrow Gastroenterology and Liver Centre Royal Prince Alfred Hospital, and University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Weltman","sequence":"additional","affiliation":[{"name":"Hepatology Services, Nepean Hospital  Penrith New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Thompson","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology St Vincent's Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9329-8018","authenticated-orcid":false,"given":"Miriam T.","family":"Levy","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Liver Liverpool Hospital  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Leggett","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital and Faculty of Medicine The University of Queensland  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amany","family":"Zekry","sequence":"additional","affiliation":[{"name":"St George and Sutherland Clinical School of Medicine, University of New South Wales, Department of Gastroenterology and Hepatology St George Hospital  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y. 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