Fatores associados ao óbito por causas relacionadas à hepatite C em Belo Horizonte, entre os casos notificados no Sistema Nacional de Agravos de Notificação (SINAN) no período de 2007 a 2013

Abstract

Hepatitis C is a relevant public health problem and it is estimated that 160 million people are infected worldwide. It is an important morbidity and mortality cause, but can be prevented and treated. In Brazil, the Sistema Único de Saúde (SUS) has adopted measures to control this epidemic with the availability of expensive exams and drugs for the population, rigorous blood bank control and health surveillance in medical and surgical procedures, reducing significantly the transmission by these mechanisms. However, there is a large contingent of people who have become infected in the past and the National System of Notifiable Diseases (Sinan) recorded an increasing rate of detection in all regions of the country by 2015. Other forms of exposure are also important in virus transmission, such as injecting and inhalable drugs, sexual and vertical exposure. The objective of this study was to know the epidemiological profile of this infection among the cases reported in Belo Horizonte and the factors associated with death. It is a non-concurrent cohort study with 1,203 cases selected in Sinan, from 2007 to 2013, of people living in Belo Horizonte. Sociodemographic, care-related variables, coinfections and exposures were analyzed by multivariate logistic regression adjusted for time between reporting and outcome or completion of the observation period to estimate factors associated with death. A higher proportion of men was reported (57.2%), the mean age at notification was 52.3 years with a 25th percentile (Q1) 44 years and a 75th percentile (Q3) 61 years. The viral load test was not performed in 18.5% of the cases and was detectable in 93.1% among people who took the test. Genotype 1 was the most prevalent with 78% of cases, and genotype 3, with 15.1%. Two hundred and sixty-nine people (22.4%) received antiviral treatment. It was find 139 deaths (11.6%). The multivariate analysis showed that the no treatment in people who remained until 1038 days of observation (OR = 4,8; 95% CI 1.7-12.5), received blood transfusion (OR= 2,6; 95% CI 1.5-4.6), male (OR = 2.0, 95% CI 1.3-6.1) and aged 45-60 years (OR = 2.8; 95% CI 1.5-4.6) and over 60 years (OR= 4.7, 95% CI 2.0-10.7) were associated with death (p <0.05). This study points to the need for adequacy in the strategy control of this aggravation in the city with prioritization serological screening in populations at greater risk including people born until 1970, intensification epidemiological surveillance, faster diagnosis and increasing access to treatment. Public policies aimed at changing behavioral risk patterns, providing reduction of exposure and damages are necessary.