Mei Lu1, Yueren Zhou2, Irina V Haller3, Robert J Romanelli4, Jeffrey J VanWormer5, Carla V Rodriguez6, Heather Anderson7, Joseph A Boscarino8, Mark A Schmidt9, Yihe G Daida10, Amandeep Sahota11, Jennifer Vincent12, Christopher L Bowlus13, Keith Lindor14, Talan Zhang2, Sheri Trudeau2, Jia Li2, Loralee B Rupp15, Stuart C Gordon16. 1. Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan. Electronic address: mlu1@hfhs.org. 2. Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan. 3. Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota. 4. Palo Alto Medical Foundation Research Institute, Palo Alto, California. 5. Marshfield Clinic Research Foundation, Marshfield, Wisconsin. 6. Center for Health Research, Kaiser Permanente Mid-Atlantic Research Institute, Rockville, Maryland. 7. Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado. 8. Department of Epidemiology and Health Services Research, Geisinger Clinic, Danville, Pennsylvania. 9. Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. 10. Center for Health Research Hawai'i, Kaiser Permanente, Honolulu, Hawaii. 11. Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, California. 12. Baylor, Scott and White Research Institute, Temple, Texas. 13. University of California Davis School of Medicine, Sacramento, California. 14. College of Health Solutions, Arizona State University, Phoenix, Arizona. 15. Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan. 16. Department of Gastroenterology and Hepatology, Henry Ford Health System, Detroit, Michigan.
Abstract
BACKGROUND & AIMS: There are few data from longitudinal studies of trends in primary biliary cholangitis (PBC) among patients under routine clinical care in the United States. We collected data from the Fibrotic Liver Disease consortium to investigate changes in the incidence and prevalence of PBC and the effects of patient demographics, clinical features, and treatment on mortality. METHODS: We collected demographic and clinical data for the general patient population as well as PBC patients receiving care from 11 health systems in different regions of the United States (Northeast, Midwest, Northwest, and South) from January 1, 2003, through December 31, 2014. Annual percentage changes in PBC prevalence and incidence were estimated using join-point Poisson regression. Differences based on race, age, and gender were calculated with rate ratios. All-cause mortality was estimated using Cox regression with adjustment for patient characteristics and treatment with ursodeoxycholic acid (UDCA). Propensity scores were used to adjust for treatment selection bias. Analyses were adjusted by geographic regions. RESULTS: In our racially diverse cohort of 3488 patients with PBC (21% Hispanic, 8% African American, 7% Asian American), 70% had ever received UDCA. From 2006 through 2014, the prevalence of PBC increased from 21.7 to 39.2 per 100,000 persons. Adjusted annual percentage changes in prevalence differed among age groups (≤40 y, 41-50 y, 51-60 y, 61-70 y, and >70 y), ranging from 3.0% to 7.5% (P < .05). Incidence did not change significantly during the study period (4.2 vs 4.3 per 100,000 person-years in 2006 and 2014, respectively; P = .98). Ratios of prevalence for women vs men (3.9:1) and incidence for women vs men (3.2:1) were consistent over the study period. Among African Americans, the prevalence of PBC increased from 16.9 to 30.8 per 100,000 during the study period, and annual incidence ranged from 2.6 to 6.6 per 100,000 person-years. In adjusted analyses, an increased level of alkaline phosphatase at baseline was associated with significantly higher mortality (adjusted hazard ratios [aHR], 1.24; 95% CI, 1.04-1.48 for patients with levels 1-2 times the upper limit of normal and aHR, 2.27; 95% CI, 1.88-2.73 for patients with levels more than 3 times the upper limit of normal). UDCA treatment was associated with significantly reduced mortality (aHR, 0.57; 95% CI, 0.52-0.64). CONCLUSIONS: In an analysis of data from patients receiving routine clinical care in Fibrotic Liver Disease Consortium health systems, we found that the prevalence of PBC increased from 2004 through 2014, despite steady incidence. Patient demographic and clinical characteristics, as well as UDCA treatment, affected mortality.
BACKGROUND & AIMS: There are few data from longitudinal studies of trends in primary biliary cholangitis (PBC) among patients under routine clinical care in the United States. We collected data from the Fibrotic Liver Disease consortium to investigate changes in the incidence and prevalence of PBC and the effects of patient demographics, clinical features, and treatment on mortality. METHODS: We collected demographic and clinical data for the general patient population as well as PBCpatients receiving care from 11 health systems in different regions of the United States (Northeast, Midwest, Northwest, and South) from January 1, 2003, through December 31, 2014. Annual percentage changes in PBC prevalence and incidence were estimated using join-point Poisson regression. Differences based on race, age, and gender were calculated with rate ratios. All-cause mortality was estimated using Cox regression with adjustment for patient characteristics and treatment with ursodeoxycholic acid (UDCA). Propensity scores were used to adjust for treatment selection bias. Analyses were adjusted by geographic regions. RESULTS: In our racially diverse cohort of 3488 patients with PBC (21% Hispanic, 8% African American, 7% Asian American), 70% had ever received UDCA. From 2006 through 2014, the prevalence of PBC increased from 21.7 to 39.2 per 100,000 persons. Adjusted annual percentage changes in prevalence differed among age groups (≤40 y, 41-50 y, 51-60 y, 61-70 y, and >70 y), ranging from 3.0% to 7.5% (P < .05). Incidence did not change significantly during the study period (4.2 vs 4.3 per 100,000 person-years in 2006 and 2014, respectively; P = .98). Ratios of prevalence for women vs men (3.9:1) and incidence for women vs men (3.2:1) were consistent over the study period. Among African Americans, the prevalence of PBC increased from 16.9 to 30.8 per 100,000 during the study period, and annual incidence ranged from 2.6 to 6.6 per 100,000 person-years. In adjusted analyses, an increased level of alkaline phosphatase at baseline was associated with significantly higher mortality (adjusted hazard ratios [aHR], 1.24; 95% CI, 1.04-1.48 for patients with levels 1-2 times the upper limit of normal and aHR, 2.27; 95% CI, 1.88-2.73 for patients with levels more than 3 times the upper limit of normal). UDCA treatment was associated with significantly reduced mortality (aHR, 0.57; 95% CI, 0.52-0.64). CONCLUSIONS: In an analysis of data from patients receiving routine clinical care in Fibrotic Liver Disease Consortium health systems, we found that the prevalence of PBC increased from 2004 through 2014, despite steady incidence. Patient demographic and clinical characteristics, as well as UDCA treatment, affected mortality.
Authors: Mehmet Sayiner; Maria Stepanova; Leyla De Avila; Pegah Golabi; Andrei Racila; Zobair M Younossi Journal: Dig Dis Sci Date: 2019-08-27 Impact factor: 3.199
Authors: Maren H Harms; Rozanne C de Veer; Willem J Lammers; Christophe Corpechot; Douglas Thorburn; Harry L A Janssen; Keith D Lindor; Palak J Trivedi; Gideon M Hirschfield; Albert Pares; Annarosa Floreani; Marlyn J Mayo; Pietro Invernizzi; Pier Maria Battezzati; Frederik Nevens; Cyriel Y Ponsioen; Andrew L Mason; Kris V Kowdley; Bettina E Hansen; Henk R van Buuren; Adriaan J van der Meer Journal: Gut Date: 2019-12-16 Impact factor: 31.793