Geo-epidemiology and environmental co-variate mapping of primary biliary cholangitis and primary sclerosing cholangitis

Autor: David Jones, Steven Rushton, Mark Hudson, Jessica K Dyson, Mark D. F. Shirley, Alasdair P. Blain
Jazyk: angličtina
Rok vydání: 2021
Předmět:
medicine.medical_specialty
AILD
autoimmune liver disease
Population
Socio-economic status
Prevalence
CFI
comparative fit index
BECs
biliary epithelial cells
Geo-epidemiology
Autoimmune hepatitis
Disease
digestive system
Primary sclerosing cholangitis
DIC
deviance information criterion
Environmental health
Epidemiology
Internal Medicine
medicine
Immunology and Allergy
Urban
Rural
AHSN NENC
Academic Health Science Network for the North East and North Cumbria
lcsh:RC799-869
education
education.field_of_study
Hepatology
SEM
structural equation modelling
business.industry
AIH
autoimmune hepatitis
Primary biliary cholangitis
Gastroenterology
SFS
superfund toxic waste site
RMSEA
root mean square error of association
medicine.disease
digestive system diseases
Social deprivation
PSC
primary sclerosing cholangitis
IMD
Index of Multiple Deprivation
lcsh:Diseases of the digestive system. Gastroenterology
PBC
primary biliary cholangitis
Rural area
business
Research Article
Cadmium
Zdroj: JHEP Reports, Vol 3, Iss 1, Pp 100202-(2021)
JHEP Reports
ISSN: 2589-5559
Popis: Background & Aims Autoimmune liver disease (AILD) is thought to result from a complex interplay between genetics and the environment. Studies to date have focussed on primary biliary cholangitis (PBC) and demonstrated higher disease prevalence in more urban, polluted, and socially deprived areas. This study utilises a large cohort of patients with PBC and primary sclerosing cholangitis (PSC) to investigate potential environmental contributors to disease and to explore whether the geo-epidemiology of PBC and PSC are disease-specific or pertain to cholestatic AILD in general. Methods All adult patients with PBC and PSC in a tightly defined geographical area within the UK were identified. Point- and area-based analyses and structural equation modelling (SEM) were used to investigate for disease clustering and examine for relationships between prevalence, distribution of environmental contaminants, and socio-economic status. Results We identified 2,150 patients with PBC and 472 with PSC. Significant spatial clustering was seen for each disease. A high prevalence of PBC was found in urban, post-industrial areas with a strong coal-mining heritage and increased environmental cadmium levels, whereas a high PSC prevalence was found in rural areas and inversely associated with social deprivation. Conclusions This study demonstrates spatial clustering of PBC and PSC and adds to our understanding of potential environmental co-variates for both diseases. Disease clustering, within the same geographical area but over different scales, is confirmed for each disease with distinct risk profiles identified and associations with separate putative environmental factors and socio-economic status. This suggests that different triggers and alternative pathways determine phenotypic expression of autoimmunity in the affected population. Co-variate analysis points towards the existence of specific disease triggers. Lay summary This study looked for potential environmental triggers in patients with primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) living in the north-east of England and north Cumbria. We found that PBC was more common in urban areas with a history of coal mining and high levels of cadmium whereas PSC was more common in rural areas with lower levels of social deprivation.
Graphical abstract
Highlights • Clustering of PBC and PSC patients occurs with notable geographical differences. • A high prevalence of PBC is seen in urban, post-industrial areas. • PSC is more common in rural areas and inversely associated with social deprivation. • PBC risk is associated with proximity to coal mines and environmental cadmium levels. • Comprehensive epidemiological study can increase understanding of disease aetiology.
Databáze: OpenAIRE
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