{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T10:34:10Z","timestamp":1788690850211,"version":"build-2803163510"},"reference-count":17,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2016,4,3]],"date-time":"2016-04-03T00:00:00Z","timestamp":1459641600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100005564","name":"Gilead Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005564","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007217","name":"Health Services Research and Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007217","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Viral Hepatitis"],"published-print":{"date-parts":[[2016,9]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p>The chronic hepatitis C (<jats:styled-content style=\"fixed-case\">CHC<\/jats:styled-content>) cohort in the United States is getting older. Elderly patients with <jats:styled-content style=\"fixed-case\">CHC<\/jats:styled-content> may be at a high risk of cirrhosis and hepatocellular carcinoma (<jats:styled-content style=\"fixed-case\">HCC<\/jats:styled-content>), but also other nonhepatic comorbidities that negatively impact their likelihood of receiving or responding to antiviral treatment. There is little information on the clinical epidemiology or outcomes of <jats:styled-content style=\"fixed-case\">CHC<\/jats:styled-content> and its treatment in the elderly. We conducted a retrospective cohort study of 1 61 744 patients with a positive Hepatitis C virus <jats:styled-content style=\"fixed-case\">RNA<\/jats:styled-content> in the Veterans Health Administration Hepatitis C Clinical Case Registry to examine the association between age subgroups (20\u201349, 50\u201364, 65\u201385 years) and risk of cirrhosis, <jats:styled-content style=\"fixed-case\">HCC<\/jats:styled-content> or death using Cox proportional hazards models. We also examined the effect of treatment with a sustained viral response (<jats:styled-content style=\"fixed-case\">SVR<\/jats:styled-content>) on these outcomes in each age subgroup. The age distribution was 36.8% 20\u2010 to 49\u2010year\u2010olds, 57.6% 50\u2010 to 64\u2010year\u2010olds and 5.6% 65\u2010 to 85\u2010year\u2010olds (i.e. elderly). Risk of cirrhosis, <jats:styled-content style=\"fixed-case\">HCC<\/jats:styled-content> and death was significantly elevated in elderly patients [<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> cirrhosis = 1.14 (1.00\u20131.29), <jats:styled-content style=\"fixed-case\">HR HCC<\/jats:styled-content> = 2.44 (1.99\u20132.99); <jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> death 2.09 (1.98\u20132.22)] compared with younger patients. The incidence of <jats:styled-content style=\"fixed-case\">HCC<\/jats:styled-content> was than 8.4 per 1000 <jats:styled-content style=\"fixed-case\">PY<\/jats:styled-content> in the elderly compared with 2.6 per 1000 <jats:styled-content style=\"fixed-case\">PY<\/jats:styled-content> and 5.7 per 1000 <jats:styled-content style=\"fixed-case\">PY<\/jats:styled-content>, among the 20\u201349 and 50\u201364 age groups, respectively. Elderly patients were significantly less likely to receive antiviral treatment (3.8% <jats:italic>vs<\/jats:italic> 14.8% and 19.1%, <jats:italic>P<\/jats:italic> &lt; 0.0001), but among those who received treatment <jats:styled-content style=\"fixed-case\">SVR<\/jats:styled-content> was not different among the age groups (33.5% <jats:italic>vs<\/jats:italic> 33.2% and 32.1%). In an analysis limited to those who received treatment, <jats:styled-content style=\"fixed-case\">SVR<\/jats:styled-content> compared to treatment receipt with no <jats:styled-content style=\"fixed-case\">SVR<\/jats:styled-content> was associated with a reduction in risk of developing cirrhosis (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> = 0.34; 0.18\u20130.66) and <jats:styled-content style=\"fixed-case\">HCC<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> = 0.60; 0.22\u20131.61) and all\u2010cause mortality risk (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> = 0.52, 0.33\u20130.82). Elderly patients with <jats:styled-content style=\"fixed-case\">CHC<\/jats:styled-content> are more likely to develop <jats:styled-content style=\"fixed-case\">HCC<\/jats:styled-content> than younger patients but have traditionally received less antiviral treatment than younger patients. However, receipt of curative treatment is associated with a benefit in reducing cirrhosis, <jats:styled-content style=\"fixed-case\">HCC<\/jats:styled-content> and overall mortality, irrespective of age.<\/jats:p>","DOI":"10.1111\/jvh.12533","type":"journal-article","created":{"date-parts":[[2016,4,4]],"date-time":"2016-04-04T04:49:09Z","timestamp":1459745349000},"page":"687-696","source":"Crossref","is-referenced-by-count":45,"title":["Epidemiology and outcomes of hepatitis C infection in elderly <scp>US<\/scp> Veterans"],"prefix":"10.1111","volume":"23","author":[{"given":"H. B.","family":"El\u2010Serag","sequence":"first","affiliation":[{"name":"Center for Innovations in Quality Effectiveness and Safety Michael E. DeBakey Veterans Affairs Medical Center Houston Texas USA"},{"name":"Section of Gastroenterology and Hepatology Department of Medicine Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Kramer","sequence":"additional","affiliation":[{"name":"Center for Innovations in Quality Effectiveness and Safety Michael E. DeBakey Veterans Affairs Medical Center Houston Texas USA"},{"name":"Section of Health Services Research Department of Medicine Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Z.","family":"Duan","sequence":"additional","affiliation":[{"name":"Section of Health Services Research Department of Medicine Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Kanwal","sequence":"additional","affiliation":[{"name":"Center for Innovations in Quality Effectiveness and Safety Michael E. DeBakey Veterans Affairs Medical Center Houston Texas USA"},{"name":"Section of Gastroenterology and Hepatology Department of Medicine Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,4,3]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.27978"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-144-10-200605160-00004"},{"issue":"513","key":"e_1_2_12_4_1","first-page":"521","article-title":"Aging of hepatitis C virus (HCV)\u2010infected persons in the United States: a multiple cohort model of HCV prevalence and disease progression","volume":"138","author":"Davis GL","year":"2010","journal-title":"Gastroenterology"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2006.00556.x"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2014.11"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2013.12.011"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1197\/jamia.M3203"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2007.03572.x"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21662"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2011.03.004"},{"key":"e_1_2_12_12_1","volume-title":"Association Between Severe Portal Hypertension and Risk of Liver Decompensation in Patients With Hepatitis C","author":"Lens S","year":"2015"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2013.08.034"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2015.08.014"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1214854"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1214853"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2013.06.024"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2013.04.003"}],"container-title":["Journal of Viral Hepatitis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fjvh.12533","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fjvh.12533","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jvh.12533","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,16]],"date-time":"2023-09-16T01:56:27Z","timestamp":1694829387000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jvh.12533"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,4,3]]},"references-count":17,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2016,9]]}},"alternative-id":["10.1111\/jvh.12533"],"URL":"https:\/\/doi.org\/10.1111\/jvh.12533","archive":["Portico"],"relation":{},"ISSN":["1352-0504","1365-2893"],"issn-type":[{"value":"1352-0504","type":"print"},{"value":"1365-2893","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,4,3]]}}}