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. 2016 May 19:6:25906.
doi: 10.1038/srep25906.

Evolving Trends in Female to Male Incidence and Male Mortality of Primary Biliary Cholangitis

Ana Lleo  1 , Peter Jepsen  2   3 , Emanuela Morenghi  4 , Marco Carbone  1 , Luca Moroni  5 , Pier Maria Battezzati  6 , Mauro Podda  1 , Ian R Mackay  7 , M Eric Gershwin  8 , Pietro Invernizzi  1   8   9
Affiliations

Evolving Trends in Female to Male Incidence and Male Mortality of Primary Biliary Cholangitis

Ana Lleo et al. Sci Rep. .

Abstract

Primary biliary cholangitis (PBC) has been regarded as female-predominant without evidence of gender difference in survival. We aimed to compare the overall survival, incidence and prevalence of PBC in two well defined population-based studies over a recent decade, considering also sex ratios and mortality. We have taken advantage of population-wide records, during 2000-2009, in Lombardia, Northern Italy, and Denmark. We focused on the incident cases of PBC, including gender and outcome, among 9.7 million inhabitants of Lombardia and 5.5 million of Denmark. In Lombardia there were 2,970 PBC cases with a female:male ratio of 2.3:1. The age/sex-adjusted annual incidence of PBC was 16.7 per million. Point prevalence was 160 per million on January 1(st) 2009. In Denmark there were 722 cases of incident PBC, female:male ratio was 4.2:1, and the annual incidence was 11.4 per million, a point prevalence of 115 per million in 2009. Cox regression multivariate analysis identified male sex as an independent predictor of all-cause mortality in both Italian (HR 2.36) and Danish population (HR 3.04). Our data indicate for PBC a sex ratio significantly lower than previously cited, a reversal of the usual latitudinal difference in prevalence and a surprisingly higher overall mortality for male patients.

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Figures

Figure 1
Figure 1. Standard incidence rate in Lombardia and Denmark.
(A) the trend between both populations was not homogeneous as confirmed by the regression model applied (Lombardia Poisson regression rate P < 0.0005, Denmark Poisson regression rate P = 0.48). (B) We therefore assume a 4-year washout in order to avoid SIR overestimation and determined a six year span time (from Jan 1st 2004 to Dec 31st 2009) with no significant variation of SIR (P = 0.15).
Figure 2
Figure 2. PBC point prevalence in Lombardia and Denmark from 2000 to 2009.
The figure shows that whereas point prevalence remains constant during the study time in Denmark (Poisson P = 0.12), it increases from 2000 to 2009 (P < 0.0005) (A,B). This dynamics is observed in both male and females (A).
Figure 3
Figure 3
Survival and sex specific survival from diagnosis in Lombardia (A,B) and Denmark (C,D). The figure shows higher mortality of PBC male patients in both populations. CI of 95%.
Figure 4
Figure 4. Relative survival rates (RSR) for PBC, by sex in both Lombardian and Danish population.
The figure shows lower RSR of PBC male patients in both populations, all the groups show RSR < 1. Bands indicate 95% CI.
See this image and copyright information in PMC

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