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Background <p>Migrants in Europe are disproportionately affected by hepatitis B virus (HBV) infection, especially those coming from endemic countries. We aimed to determine whether migrant status was associated with all-cause mortality risk in people living with chronic HBV infection integrated into a hospital-based care pathway in France.</p> Methods <p>We analysed clinical and socio-behavioural data collected over 8&#xa0;years of follow-up among patients with chronic HBV infection enrolled in the French prospective multicentre cohort ANRS CO22 HEPATHER. Migrant status was tested as a binary variable (non-migrants versus migrants) and according to three categories (low, moderate, and high) of HBV endemicity in the migrants’ region of birth. The association between migrant status and all-cause mortality risk was assessed using a multivariable Cox proportional hazards model. A competing risks analysis was conducted for liver-related and non-liver-related mortality.</p> Results <p>Of the 5597 study participants, accounting for 33,222.8 person-years (PY), 68.1% were migrants, mainly from Sub-Saharan Africa and Asia. During follow-up, 247 patients died and the all-cause mortality rate [95% confidence interval (CI)] was 7.4 [6.6–8.4]/1000 PY. Migrants had a lower mortality rate than non-migrants: 4.5 [3.7–5.5]/1000 PY versus 13.5 [11.4–15.8]/1000 PY (<i>p</i>&#xa0;&lt;&#xa0;0.001), irrespective of migrants’ region of birth and time since arrival in France. After adjustment for sex, age, living in poverty, alcohol use, tobacco smoking, diabetes, and HBV disease phase, the all-cause mortality risk was still lower in migrants than in non-migrants (adjusted hazard ratio [95% CI] 0.58 [0.43–0.78], <i>p</i>&#xa0;&lt;&#xa0;0.001). All three migrant HBV endemicity categories had a lower risk of all-cause and non-liver-related mortality than non-migrants. By contrast, these differences were not significant for liver-related mortality.</p> Conclusions <p>A lower all-cause, liver-related and non-liver-related mortality risk was found among migrants with chronic HBV infection in France compared to non-migrants. However, after multivariable adjustment, the liver-related mortality risk was similar between migrants and non-migrants, indicating that mortality advantage for migrants is explained by the protective adjustment factors, such as younger age, less advanced liver disease and fewer unhealthy behaviours. In contrast, these factors did not fully explain the observed mortality advantage for both non-liver-related and all-cause mortality.</p> Trial registration <p>ClinicalTrials.gov registry number: NCT01953458.</p>

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Mortality risk in migrant and non-migrant individuals with chronic hepatitis B virus infection: a French hospital-based cohort study (ANRS CO22 HEPATHER)

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  • 发表日期：

    2025年7月1日

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  • Marta Lotto,
  • Clémence Ramier,
  • Fabrice Carrat,
  • Lauren Périères,
  • Elisabeth Delaroque-Astagneau,
  • Jérôme Nicol,
  • Fabienne Marcellin,
  • Fabien Zoulim,
  • Vincent Di Beo,
  • Mathilde Bertheau,
  • Stanislas Pol,
  • Camelia Protopopescu,
  • Marc Bourlière,
  • Patrizia Carrieri,
  • Laurent Alric,
  • Delphine Bonnet,
  • Océane Camou,
  • Marianne Maynard,
  • François Bailly,
  • Bénédicte Poumaroux,
  • Miroslava Subic,
  • François Raffi,
  • Eric Billaud,
  • David Boutoille,
  • Maeva Lefebvre,
  • Elisabeth André-Garnier,
  • Paul Cales,
  • Isabelle Hubert,
  • Clémence Canivet,
  • Françoise Lunel,
  • Tarik Asselah,
  • Nathalie Boyer,
  • Nathalie Giuily,
  • Corinne Castelnau,
  • Giovanna Scoazec,
  • Hélène Fontaine,
  • Lucia Parlati,
  • Emilie Rousseaud,
  • Anaïs Vallet-Pichard,
  • Philippe Sogni,
  • Victor de Ledinghen,
  • Juliette Foucher,
  • Jean-Baptiste Hiriart,
  • Paul Hermabessière,
  • Marie Irlès-Depé,
  • Si Nafa Si Ahmed,
  • Valérie Oules,
  • Rania Kibeche,
  • Albert Tran,
  • Rodolphe Anty,
  • Eve Gelsi,
  • Régine Truchi,
  • Dominique Thabut,
  • Saloua Hammeche,
  • Joseph Moussali,
  • Xavier Causse,
  • Barbara De Dieuleveult,
  • Brahim Ouarani,
  • Damien Labarrière,
  • Magali Jeulin,
  • Nathalie Ganne,
  • Véronique Grando-Lemaire,
  • Pierre Nahon,
  • Séverine Brulé,
  • Lucie Del Pozo,
  • Caroline Jezequel,
  • Audrey Brener,
  • François Habersetzer,
  • Thomas F. Baumert,
  • Lawrence Serfaty,
  • Pauline Simo-Noumbissie,
  • Alexandre Bolle,
  • Jean-Pierre Bronowicki,
  • Mouni Bensenane-Oussalah,
  • Vincent Haghnejad,
  • Sébastien Daude,
  • Sarah Hadj-Rhouma,
  • Georges-Philippe Pageaux,
  • Dominique Larrey,
  • Magda Meszaros,
  • Sophie Metivier,
  • Christophe Bureau,
  • Thibault Morales,
  • Jean Marie Peron,
  • Hélène Larrue,
  • Thomas Decaens,
  • Marie-Noelle Hilleret,
  • Charlotte Costentin,
  • Bleuenn Brusset,
  • Agnès Bonadona,
  • Ghassan Riachi,
  • Odile Goria,
  • Fatima Paris,
  • Hélène Montialoux,
  • Vincent Leroy,
  • Giuliana Amaddeo,
  • Anne Varaut,
  • Mélanie Simoes,
  • Rachida Amzal,
  • Slim Fourati,
  • Olivier Chazouillières,
  • Tony Andreani,
  • Bénédicte Angoulevant,
  • Azeline Chevance,
  • Jean-Charles Duclos Vallée,
  • Audrey Coilly,
  • Rodolphe Sobesky,
  • Alina Pascale,
  • Benjamin Buchard,
  • Armand Abergel,
  • Maud Reymond,
  • Chanteranne Brigitte,
  • Léon Muti,
  • Vincent Di Martino,
  • Claire Geist,
  • Guillaume Conroy,
  • Raphaëlle Riffault,
  • Isabelle Rosa,
  • Camille Barrault,
  • Laurent Costes,
  • Anne Wampach,
  • Véronique Loustaud-Ratti,
  • Paul Carrier,
  • Maryline Debette-Gratien,
  • Christine Silvain,
  • Valentin Rolle,
  • Valérie Roumy,
  • Astrid Guyot d’Asnières de Salins,
  • Philippe Mathurin,
  • Guillaume Lassailly,
  • Elise Lemaitre,
  • Valérie Canva,
  • Sébastien Dharancy,
  • Alexandre Louvet,
  • Anne Minello,
  • Marianne Latournerie,
  • Thomas Mouillot,
  • Léa Lerosey,
  • Théophile Gerster,
  • Dominique Roulot,
  • Zahia Ben Abdesselam,
  • Louis D’Alteroche,
  • Coralie Fleurent,
  • Charlotte Nicolas,
  • Laure Elkrief,
  • Anaïs Jaillais,
  • Denis Ouzan,
  • Jérôme Gournay,
  • Caroline Chevalier,
  • Isabelle Archambeaud,
  • Isabelle Portal,
  • Thông Dao,
  • Moana Gelu-Simeon,
  • Marie-Josée Lafrance,
  • Lucie Catherine,
  • Cécile Brouard,
  • Elisabeth Delarocque-Astagneau,
  • Chantal Housset,
  • Linda Wittkop,
  • Jessica Zucman-Rossi,
  • Marianne L’hennaff,
  • Michèle Sizorn,
  • Ventzislava Petrov-Sanchez,
  • Carole Cagnot,
  • Cécile Moins,
  • Anais Boston,
  • Elise Landry,
  • Guillaume Le Meut,
  • Alpha Diallo,
  • Frederic Chau,
  • Céline Dorival,
  • Isabelle Goderel,
  • Clovis Lusivika-Nzinga,
  • Jonathan Bellet,
  • Jessica Chane-Teng,
  • Grégory Pannetier,
  • Jérôme Nicol

摘要

Background

Migrants in Europe are disproportionately affected by hepatitis B virus (HBV) infection, especially those coming from endemic countries. We aimed to determine whether migrant status was associated with all-cause mortality risk in people living with chronic HBV infection integrated into a hospital-based care pathway in France.

Methods

We analysed clinical and socio-behavioural data collected over 8 years of follow-up among patients with chronic HBV infection enrolled in the French prospective multicentre cohort ANRS CO22 HEPATHER. Migrant status was tested as a binary variable (non-migrants versus migrants) and according to three categories (low, moderate, and high) of HBV endemicity in the migrants’ region of birth. The association between migrant status and all-cause mortality risk was assessed using a multivariable Cox proportional hazards model. A competing risks analysis was conducted for liver-related and non-liver-related mortality.

Results

Of the 5597 study participants, accounting for 33,222.8 person-years (PY), 68.1% were migrants, mainly from Sub-Saharan Africa and Asia. During follow-up, 247 patients died and the all-cause mortality rate [95% confidence interval (CI)] was 7.4 [6.6–8.4]/1000 PY. Migrants had a lower mortality rate than non-migrants: 4.5 [3.7–5.5]/1000 PY versus 13.5 [11.4–15.8]/1000 PY (p < 0.001), irrespective of migrants’ region of birth and time since arrival in France. After adjustment for sex, age, living in poverty, alcohol use, tobacco smoking, diabetes, and HBV disease phase, the all-cause mortality risk was still lower in migrants than in non-migrants (adjusted hazard ratio [95% CI] 0.58 [0.43–0.78], p < 0.001). All three migrant HBV endemicity categories had a lower risk of all-cause and non-liver-related mortality than non-migrants. By contrast, these differences were not significant for liver-related mortality.

Conclusions

A lower all-cause, liver-related and non-liver-related mortality risk was found among migrants with chronic HBV infection in France compared to non-migrants. However, after multivariable adjustment, the liver-related mortality risk was similar between migrants and non-migrants, indicating that mortality advantage for migrants is explained by the protective adjustment factors, such as younger age, less advanced liver disease and fewer unhealthy behaviours. In contrast, these factors did not fully explain the observed mortality advantage for both non-liver-related and all-cause mortality.

Trial registration

ClinicalTrials.gov registry number: NCT01953458.