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We aimed to quantify life expectancy (LE) differences between treated and untreated individuals diagnosed with HCV and assess the contributions of age and causes of death to these differences. We used routine HCV surveillance data linked with UK mortality records. Individuals contributed person\u2010time from age 15 or the earliest HCV diagnosis, whichever was later, and were classified as treated six months post\u2010treatment initiation. The study was divided into two periods: 2015\u20132018 (Period 1), representing early DAA roll\u2010out targeting advanced liver disease, and 2019\u20132022 (Period 2). We used non\u2010parametric survival analysis methods and mortality decomposition methods to estimate LE differences, and age\u2010 and cause\u2010specific contributions to LE differences. A total of 92,920 individuals contributed 322,570 untreated and 200,581 treated person\u2010years of observation, and 13,294 deaths to the analyses. In Period 1, there was an 8.5\u2010year LE advantage at age 15 for treated females (95% CI: 5.4\u201311.5) and 8.9\u2009years for treated males (95% CI: 5.6\u201312.2). In Period 2, this declined to 6.7 (95% CI: 3.3\u201310.2) and 5.3 (95% CI: 3.0\u20137.6), respectively. The narrowing gap was driven by rising deaths from suicide, alcohol, and drug misuse in the treated population and corresponding declines in the untreated population. Treated individuals with HCV had consistently higher LE, though the advantage decreased over time. We hypothesise that the early prioritisation of individuals with cirrhosis resulted in a relatively healthier untreated population (i.e., fewer cirrhotic cases) in the later period.<\/jats:p>","DOI":"10.1111\/jvh.70210","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T04:56:06Z","timestamp":1783918566000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Trends in Mortality After the Roll\u2010Out of Directly Acting Antivirals for Hepatitis C in England Using Linked Surveillance Data"],"prefix":"10.1111","volume":"33","author":[{"given":"David","family":"Etoori","sequence":"first","affiliation":[{"name":"Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health University College London  London UK"},{"name":"Health Protection Research Unit (HPRU) in Blood\u2010Borne and Sexually Transmitted Infections at UCL National Institute for Health and Care Research (NIHR)  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"Simmons","sequence":"additional","affiliation":[{"name":"Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division UK Health Security Agency  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annabel","family":"Powell","sequence":"additional","affiliation":[{"name":"Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division UK Health Security Agency  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Desai","sequence":"additional","affiliation":[{"name":"Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division UK Health Security Agency  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Trembling","sequence":"additional","affiliation":[{"name":"Institute for Liver and Digestive Health, Division of Medicine University College London, Royal Free Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5173-2760","authenticated-orcid":false,"given":"Caroline","family":"Sabin","sequence":"additional","affiliation":[{"name":"Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health University College London  London UK"},{"name":"Health Protection Research Unit (HPRU) in Blood\u2010Borne and Sexually Transmitted Infections at UCL National Institute for Health and Care Research (NIHR)  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Rosenberg","sequence":"additional","affiliation":[{"name":"Health Protection Research Unit (HPRU) in Blood\u2010Borne and Sexually Transmitted Infections at UCL National Institute for Health and Care Research (NIHR)  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,12]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"WHO Global hepatitis report 2024: action for access in low\u2010 and middle\u2010income countries 2024Available from https:\/\/www.who.int\/publications\/i\/item\/9789240091672."},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.4254\/wjh.v7.i24.2543"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2022.101810"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/flgastro\u20102022\u2010102373"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2011.03.004"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.05.028"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2019.06.003"},{"key":"e_1_2_11_9_1","unstructured":"WHO Global health sector strategies on HIV viral hepatitis and sexually transmitted infections for the period 2022\u20132030 2022Available from https:\/\/www.who.int\/publications\/i\/item\/9789240053779."},{"key":"e_1_2_11_10_1","unstructured":"UKHSA GOV.UK 2024Hepatitis C in England 2024. 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