Primary Biliary Cirrhosis More Severe In African-American And Hispanic Patients

Primary biliary cirrhosis is an uncommon liver disease that typically afflicts Caucasian women between ages 30 and 60, so there is little data available on how it affects non-Caucasian patients. To shed light on this topic, researchers led by Marion Peters of the University of California in 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 between ethnic groups, genders, and anti-mitochondrial antibody (AMA) status. They also compared the 265 patients who entered the trial to those who did not.

The majority of the patients considered for the trial were Caucasian (86.4 percent). Just 7.9 percent were Hispanic, and 3.9 percent 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 report. Minority patients reported more limitation of activity, more severe itching and more serious complications such as ascites, hepatic encephalopathy and variceal bleeding. Results from the laboratory tests confirmed the disparity in disease severity. Mostly as a result of their poorer health conditions, a significantly smaller proportion of non-Caucasian patients were enrolled in the trial--just 23.2 percent compared to 53.5 percent 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," the authors report.

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.

These findings are in the September issue of Hepatology, a journal published by John Wiley & Sons on behalf of the American Association for the Study of Liver Diseases (AASLD). 

Article: "Differences Between Caucasian, African American and Hispanic Patients with Primary Biliary Cirrhosis in the United States" Peters, Marion; Di Bisceglie, Adrian, Kowdley, Kris; Flye, Nancy; Luketic, Velimir; Munoz, Santiago; Garcia-Tsao, Guadalupe; Boyer, Thomas; Lake, John; Bonacini, Maurizio; Combes, Burton. Hepatology; September 2007; (DOI: 10.1002/hep.21759).