Risk factors and comorbidities in primary biliary cirrhosis: A controlled interview-based study of 1032 patients

M. Eric Gershwin, Carlo Selmi, Howard J. Worman, Ellen B Gold, Mitchell Watnik, Jessica Utts, Keith D. Lindor, Marshall M. Kaplan, John M. Vierling

Research output: Contribution to journalArticle

367 Citations (Scopus)

Abstract

Primary biliary cirrhosis (PBC) is an autoimmune disease of unknown etiology, often associated with other autoimmune conditions. Controlled studies have so far provided conflicting data on risk factors and comorbidity rates in PBC. We enrolled patients with PBC (n = 1032) from 23 tertiary referral centers for liver diseases in the United States and random-digit-dialed controls (n = 1041) matched for sex, age, race, and geographical location. Patients and controls were administered a modified version of the US National Health and Nutrition Examination Study (NHANES III) questionnaire by trained personnel to evaluate associations between PBC and social, demographic, personal and family medical histories, lifestyle, and reproductive factors and the rates of comorbidity in affected individuals. Data indicate that having a first-degree relative with PBC (adjusted odds ratio [AOR] 10.736; 95% confidence interval 4.227-27.268), history of urinary tract infections (AOR 1.511, 95% CI 1.192-1.915), past smoking (AOR 1.569, 95% CI 1.292-1.905), or use of hormone replacement therapies (AOR 1.548, 95% CI 1.273-1.882) were significantly associated with increased risk of PBC. The frequent use of nail polish slightly increased the risk of having PBC. Other autoimmune diseases were found in 32% of cases and 13% of controls (P<0.0001). In conclusion, environmental factors, possibly including infectious agents through urinary tract infections or chemicals contained in cigarette smoke, may induce PBC in genetically susceptible individuals. Exogenous estrogens may also contribute to explain the female predominance of the disease.

Original languageEnglish (US)
Pages (from-to)1194-1202
Number of pages9
JournalHepatology
Volume42
Issue number5
DOIs
StatePublished - Nov 2005

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Biliary Liver Cirrhosis
Comorbidity
Interviews
Odds Ratio
Urinary Tract Infections
Autoimmune Diseases
Medical History Taking
Industrial Oils
Nutrition Surveys
Hormone Replacement Therapy
Nails
Tertiary Care Centers
Smoke
Tobacco Products
Life Style
Liver Diseases
Estrogens
Smoking
Demography
Confidence Intervals

ASJC Scopus subject areas

  • Hepatology

Cite this

Risk factors and comorbidities in primary biliary cirrhosis : A controlled interview-based study of 1032 patients. / Gershwin, M. Eric; Selmi, Carlo; Worman, Howard J.; Gold, Ellen B; Watnik, Mitchell; Utts, Jessica; Lindor, Keith D.; Kaplan, Marshall M.; Vierling, John M.

In: Hepatology, Vol. 42, No. 5, 11.2005, p. 1194-1202.

Research output: Contribution to journalArticle

Gershwin, ME, Selmi, C, Worman, HJ, Gold, EB, Watnik, M, Utts, J, Lindor, KD, Kaplan, MM & Vierling, JM 2005, 'Risk factors and comorbidities in primary biliary cirrhosis: A controlled interview-based study of 1032 patients', Hepatology, vol. 42, no. 5, pp. 1194-1202. https://doi.org/10.1002/hep.20907
Gershwin, M. Eric ; Selmi, Carlo ; Worman, Howard J. ; Gold, Ellen B ; Watnik, Mitchell ; Utts, Jessica ; Lindor, Keith D. ; Kaplan, Marshall M. ; Vierling, John M. / Risk factors and comorbidities in primary biliary cirrhosis : A controlled interview-based study of 1032 patients. In: Hepatology. 2005 ; Vol. 42, No. 5. pp. 1194-1202.
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abstract = "Primary biliary cirrhosis (PBC) is an autoimmune disease of unknown etiology, often associated with other autoimmune conditions. Controlled studies have so far provided conflicting data on risk factors and comorbidity rates in PBC. We enrolled patients with PBC (n = 1032) from 23 tertiary referral centers for liver diseases in the United States and random-digit-dialed controls (n = 1041) matched for sex, age, race, and geographical location. Patients and controls were administered a modified version of the US National Health and Nutrition Examination Study (NHANES III) questionnaire by trained personnel to evaluate associations between PBC and social, demographic, personal and family medical histories, lifestyle, and reproductive factors and the rates of comorbidity in affected individuals. Data indicate that having a first-degree relative with PBC (adjusted odds ratio [AOR] 10.736; 95{\%} confidence interval 4.227-27.268), history of urinary tract infections (AOR 1.511, 95{\%} CI 1.192-1.915), past smoking (AOR 1.569, 95{\%} CI 1.292-1.905), or use of hormone replacement therapies (AOR 1.548, 95{\%} CI 1.273-1.882) were significantly associated with increased risk of PBC. The frequent use of nail polish slightly increased the risk of having PBC. Other autoimmune diseases were found in 32{\%} of cases and 13{\%} of controls (P<0.0001). In conclusion, environmental factors, possibly including infectious agents through urinary tract infections or chemicals contained in cigarette smoke, may induce PBC in genetically susceptible individuals. Exogenous estrogens may also contribute to explain the female predominance of the disease.",
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AB - Primary biliary cirrhosis (PBC) is an autoimmune disease of unknown etiology, often associated with other autoimmune conditions. Controlled studies have so far provided conflicting data on risk factors and comorbidity rates in PBC. We enrolled patients with PBC (n = 1032) from 23 tertiary referral centers for liver diseases in the United States and random-digit-dialed controls (n = 1041) matched for sex, age, race, and geographical location. Patients and controls were administered a modified version of the US National Health and Nutrition Examination Study (NHANES III) questionnaire by trained personnel to evaluate associations between PBC and social, demographic, personal and family medical histories, lifestyle, and reproductive factors and the rates of comorbidity in affected individuals. Data indicate that having a first-degree relative with PBC (adjusted odds ratio [AOR] 10.736; 95% confidence interval 4.227-27.268), history of urinary tract infections (AOR 1.511, 95% CI 1.192-1.915), past smoking (AOR 1.569, 95% CI 1.292-1.905), or use of hormone replacement therapies (AOR 1.548, 95% CI 1.273-1.882) were significantly associated with increased risk of PBC. The frequent use of nail polish slightly increased the risk of having PBC. Other autoimmune diseases were found in 32% of cases and 13% of controls (P<0.0001). In conclusion, environmental factors, possibly including infectious agents through urinary tract infections or chemicals contained in cigarette smoke, may induce PBC in genetically susceptible individuals. Exogenous estrogens may also contribute to explain the female predominance of the disease.

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