Longitudinal retrospective cohort study to examine liver, cardiovascular and metabolic factors as predictors of all-cause mortality in a rural population in South-West Uganda
Cori Campbell, Joseph O Mugisha, Beatrice Kimono, Elizabeth Waddilove, Ronald Makanga, Florence Nambaziira Muzaale, Tingyan Wang, Janet Seeley, Moffat Nyirenda, Philippa C Matthews, Robert NewtonIntroduction
Markers of liver and metabolic disease have not been well described for many populations in Africa, but could be important to inform individual and public health interventions that reduce morbidity and mortality.
Methods
We studied longitudinal data from a population in rural Uganda, aiming (1) to describe trends in liver function tests and (2) to investigate how liver, metabolic and cardiovascular parameters are associated with all-cause mortality. Demographic and laboratory data were collected through the General Population Cohort in South-Western Uganda. We summarised cohort characteristics at baseline using descriptive statistics and used univariable and multivariable Cox proportional hazards models to investigate factors associated with adjusted HR (aHR) for death over a 12-year period (between 2011 and 2023).
Results
Our dataset includes 7896 individuals, of whom 4441/7896 (56%) were female and 5722/7896 (72%) were aged under 45 years. Prevalence of hepatitis B virus (HBV) was 216/7896 (2.74%; 95% CI 2.38% to 3.10%) and HIV was 582/7896 (7.37%; 95% CI 6.79% to 7.94%). Alanine aminotransferase (ALT) was elevated in 2020/7896 (25.58%; 95% CI 24.62% to 26.55%). During the period observed, all-cause death was associated with older age (p<0.001), male sex (aHR 1.56, 95% CI 1.30 to 1.86) and HIV infection (aHR 1.67, 95% CI 1.25 to 2.22). Mortality was associated with an increase in aspartate aminotransferase:ALT ratio (aHR 1.17, 95% CI 1.08 to 1.26), a marker of alcoholic hepatitis. Increases in systolic blood pressure and haemoglobin A1c were also associated with significantly elevated hazards of death. Under sensitivity analysis restricted to participants with longitudinal follow-up data (n=871), HBV infection was associated with death (aHR 5.38, 95% CI 2.01 to 14.42).
Conclusions
Simple interventions to prevent, diagnose and treat hypertension, diabetes, alcohol excess, and HIV and HBV infection could have an important impact on mortality in this setting.