Article Text

Impact of HCV infection and ethnicity on incident type 2 diabetes: findings from a large population-based cohort in British Columbia
  1. Dahn Jeong1,2,
  2. Mohammad Ehsanul Karim1,3,
  3. Stanley Wong2,
  4. James Wilton2,
  5. Zahid Ahmad Butt2,4,
  6. Mawuena Binka2,
  7. Prince Asumadu Adu1,2,
  8. Sofia Bartlett2,5,
  9. Margo Pearce1,2,
  10. Emilia Clementi1,2,
  11. Amanda Yu2,
  12. Maria Alvarez2,
  13. Hasina Samji2,6,
  14. Héctor Alexander Velásquez García2,
  15. Younathan Abdia1,2,
  16. Mel Krajden2,5,
  17. Naveed Zafar Janjua1,2,3
  1. 1School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
  2. 2Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
  3. 3Centre for Health Evaluation and Outcome Sciences, St Paul’s Hospital, Vancouver, British Columbia, Canada
  4. 4School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
  5. 5Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
  6. 6Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
  1. Correspondence to Dr Naveed Zafar Janjua; naveed.janjua{at}


Introduction Increasing evidence indicates that chronic hepatitis C virus (HCV) infection is associated with higher risk of diabetes. Previous studies showed ethnic disparities in the disease burden of diabetes, with increased risk in Asian population. We described the incidence of type 2 diabetes related to HCV infection and assessed the concurrent impact of HCV infection and ethnicity on the risk of diabetes.

Research design and methods In British Columbia Hepatitis Testers Cohort, individuals were followed from HCV diagnosis to the earliest of (1) incident type 2 diabetes, (2) death or (3) end of the study (December 31, 2015). Study population included 847 021 people. Diabetes incidence rates in people with and without HCV were computed. Propensity scores (PS) analysis was used to assess the impact of HCV infection on newly acquired diabetes. PS-matched dataset included 117 184 people. We used Fine and Gray multivariable subdistributional hazards models to assess the effect of HCV and ethnicity on diabetes while adjusting for confounders and competing risks.

Results Diabetes incidence rates were higher among people with HCV infection than those without. The highest diabetes incidence rate was in South Asians with HCV (14.7/1000 person-years, 95% CI 12.87 to 16.78). Compared with Others, South Asians with and without HCV and East Asians with HCV had a greater risk of diabetes. In the multivariable stratified analysis, HCV infection was associated with increased diabetes risk in all subgroups: East Asians, adjusted HR (aHR) 3.07 (95% CI 2.43 to 3.88); South Asians, aHR 2.62 (95% CI 2.10 to 3.26); and Others, aHR 2.28 (95% CI 2.15 to 2.42).

Conclusions In a large population-based linked administrative health data, HCV infection was associated with higher diabetes risk, with a greater relative impact in East Asians. South Asians had the highest risk of diabetes. These findings highlight the need for care and screening for HCV-related chronic diseases such as type 2 diabetes among people affected by HCV.

  • HCV infection
  • ethnicity
  • epidemiology
  • longitudinal studies

Data availability statement

Data are available on reasonable request. Data are available from the BC Centre for Disease Control Institutional Data Access for researchers who meet the criteria for access to confidential data. Requests for the data may be sent to Dr Naveed Janjua (

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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Data availability statement

Data are available on reasonable request. Data are available from the BC Centre for Disease Control Institutional Data Access for researchers who meet the criteria for access to confidential data. Requests for the data may be sent to Dr Naveed Janjua (

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  • Twitter @Dahn_Jeong, @ehsan7x, @theprinceadu, @SofiaRB_88, @emilia_clementi, @HasinanisaH, @naveedjanjua

  • Contributors NZJ, MK, SW, AY, and MA participated in the data acquisition. DJ and NZJ conceived the analysis and designed the study. DJ performed analyses, wrote the first draft of the paper and incorporated revisions by NZJ and MEK. All authors contributed to data interpretation and manuscript revisions.

  • Funding This work was supported by the BC Centre for Disease Control and the Canadian Institutes of Health Research (CIHR) (Grant # NHC-348216, PJT-156066, and PHE-337680).

  • Disclaimer All inferences, opinions, and conclusions drawn in this analysis are those of the authors and do not necessarily reflect the opinions or policies of the British Columbia Ministry of Health and the Data Steward(s).

  • Competing interests DJ is supported by the CIHR Frederick Banting and Charles Best Doctoral Award and the Canadian Network on Hepatitis C PhD fellowship. MEK is supported by the Michael Smith Foundation for Health Research Scholar award and holds research grants from the Natural Sciences and Engineering Research Council of Canada and BC SUPPORT Unit. Over the past 3 years, MEK has received consulting fees from Biogen (unrelated to this project). MK has received grant/research support from Roche, Merck, Siemens, Boehringer Ingelheim and Hologic. SW, JW, ZAB, MB, PAA, SB, MP, EC, AY, MA, HS, HAVG, YA and NZJ have no conflicts of interest to declare.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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