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Risk factors and comorbidities in primary biliary cirrhosis: A controlled interview‐based study of 1032 patients
Author(s) -
Gershwin M. Eric,
Selmi Carlo,
Worman Howard J.,
Gold Ellen B.,
Watnik Mitchell,
Utts Jessica,
Lindor Keith D.,
Kaplan Marshall M.,
Vierling John M.
Publication year - 2005
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.20907
Subject(s) - medicine , primary biliary cirrhosis , comorbidity , national health and nutrition examination survey , odds ratio , etiology , confidence interval , urinary system , epidemiology , population , environmental health
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. (H EPATOLOGY 2005;42:1194–1202.)