Epidemiology

Racial differences seen in severity of primary biliary cirrhosis

Last Updated: 2007-09-20 16:29:43 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Non-Caucasians with primary biliary cirrhosis often have more severe disease at clinical presentation than Caucasians, results of a study published in the September issue of Hepatology suggest.

"Primary biliary cirrhosis (PBC) is an uncommon chronic cholestatic liver disease that primarily afflicts young and middle-aged Caucasian women; there are limited data on the clinical presentation and disease severity among non-Caucasian patients with this disease," Dr. Marion G. Peters, of the University of California, San Francisco, and colleagues write.

For their study, the researchers compared demographics, symptoms, physical findings, and laboratory tests in 535 patients with PBC being screened for a clinical trial. In addition, they compared differences between ethnic groups, gender, and antimitochondrial antibody (AMA) status. Of the 535 subjects, 462 were Caucasian, 21 were African American, 42 were Hispanic, and 10 were from other racial and ethnic groups.

Non-Caucasians were more likely than Caucasians to be ineligible to participate in the clinical trial (46.6% versus 25.1%, respectively; p = 0.0001). This was mainly due to greater disease severity observed in non-Caucasians.

African Americans and Hispanics were significantly more likely than Caucasians to have a lower activity level, severe or difficult-to-control pruritus, and more advanced disease.

There were no significant differences between non-Caucasians and Caucasians in terms of mean age, male-to-female ratio, and seroprevalence of AMA positivity.

The reasons why biliary cirrhosis is more severe in non-Caucasian patients are unclear, the researchers note. "It is not clear whether these patients had more rapid disease, less access to care early in their disease, or misdiagnoses due to inadequate testing, the absence of liver biopsies, or the presence of comorbidities that may have led to a delay in treatment."

Therefore, increased awareness of PBC as a cause of chronic cholestatic liver disease "is critical in evaluating non-Caucasian patients in the United States," Dr. Peters and colleagues conclude.

Hepatology 2007;46:769-775.