Trends and risk factors associated with hepatitis A severity and mortality in French hospitals: a national population-based study, 2013 to 2024

Background

As hepatitis A (HA) incidence declines in Europe and HA virus infections occur later in life, severe disease frequency may increase.

Aim

Among patients hospitalised for HA in France during 2013−2024, we investigated disease severity and mortality associated-risk factors and temporal trends.

Methods

International Classification of Diseases, 10th Revision codes B150 or B159 as primary discharge diagnosis enabled identifying HA cases from the National Discharge Data Set. Risk factors for severity (hepatic and/or extrahepatic organ failure within 12 weeks post-admission) and mortality were assessed using adjusted odds ratios in original and propensity-matched samples. Trends were determined across five periods covering an HA epidemic in 2017 and the COVID-19 pandemic, with 2013–2016 as reference.

Results

Among 7,923 cases (60.6% male, 39.4% female; median age: 30 years), 28.7% (n = 2,277) developed severe HA, and 1.30% (n = 103) died. Severe HA was associated with older age (+ 15% per decade over 30 years, p < 0.001), male sex (+ 38%, p < 0.001), smoking (+ 23%, p = 0.031), risk factors for chronic liver disease (+ 29%, p = 0.041), and cirrhosis (+ 40%, p = 0.054). Mortality was associated with cirrhosis (2.90-fold increase, p = 0.004), Charlson Comorbidity Index (CCI) ≥ 3 (12.3-fold increase, p < 0.001), and modestly with age (+ 24%, p = 0.005), reaching + 90% (p < 0.001) in models without CCI, indicating a considerable comorbidity effect. From 2013–2016, severe HA and HA-related death risks respectively increased 57% (p < 0.001) and 1.96-fold (p = 0.016) in 2021–2024.

Conclusions

Severe HA frequency and mortality increased in French hospitals since 2013. Age and male sex were associated with severe disease, and high CCI with mortality. A more extensive, or even universal, vaccination policy could be considered.