Primary Biliary Cirrhosis Is More Severe in African-American and Hispanic Patients Compared to Caucasians

Non-Caucasian patients seeking medical care for primary biliary cirrhosis have more severe liver disease compared to Caucasian patients, according to results of a new study published in the September 2007 issue of Hepatology. The reasons for the disparity are not known.

Primary biliary cirrhosis is an uncommon liver disease that typically affects Caucasian women between the ages of 30 and 60, so there is little data available about how it affects non-Caucasian patients. To shed light on this topic, researchers led by Marion Peters, MD, of the University of California at San Francisco set out to examine differences in disease severity among patients of various racial and ethnic groups.

They studied 535 individuals with primary biliary cirrhosis who were screened for possible enrollment into a large, national multicenter clinical trial of ursodeoxycholic acid with or without weekly methotrexate, between April 1989 and January 1998. For each patient, they collected demographic information, clinical symptoms, physical findings, and laboratory test results. They then examined differences related to ethnic group, gender, and anti-mitochondrial antibody (AMA) status. They also compared the 265 patients who entered the trial to those who did not.

The majority of patients considered for the trial were Caucasian (86.4%). Just 7.9% were Hispanic and 3.9% were African-American. Still, the researchers noticed significant differences between Caucasian and non-Caucasian patients.
"Non-Caucasians appeared to have significantly more severe liver disease than Caucasians, as assessed by history, physical examination and laboratory features," the authors wrote.

Non-Caucasian patients reported more limitation of activity, more severe itching and more serious complications such as ascites, hepatic encephalopathy, and variceal bleeding. Results of laboratory tests confirmed the disparity in disease severity. Mostly as a result of their poorer health condition, a significantly smaller proportion of non-Caucasian patients were enrolled in the trial -- just 23.2% compared to 53.5% of Caucasians.

The reasons for the health disparities are unknown, since patients in both groups were of similar age and had the disease for similar lengths of time.

"It is not clear whether these patients have more rapid disease, less access to care early in their disease, misdiagnoses due to inadequate testing, absence of liver biopsies or presence of comorbidities which may have lead to delay in treatment," wrote the authors.

To begin to address the disparity, they suggest, "primary biliary cirrhosis should be considered as the diagnosis in cholestatic liver disease in all ethnic populations."

While the disease does predominantly affect Caucasian women, this study revealed a significant number of racial minority patients, and disturbing evidence of inexplicably more advanced disease.

09/11/07

Reference
M Peters, A Di Bisceglie, K Adrian, and others. Differences Between Caucasian, African American and Hispanic Patients with Primary Biliary Cirrhosis in the United States. Hepatology (46)3: 769-775. September 2007.

_______________