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. 2018 Aug;51(5):258-264.
doi: 10.1080/08916934.2018.1482884. Epub 2018 Jun 11.

Race/ethnicity is an independent risk factor for autoimmune hepatitis among the San Francisco underserved

Briton Lee  1 , Edward W Holt  2 , Robert J Wong  3 , Justin L Sewell  4 , Ma Somsouk  4 , Mandana Khalili  4   5 , Jacquelyn J Maher  4   5 , Michele M Tana  4   5
Affiliations

Race/ethnicity is an independent risk factor for autoimmune hepatitis among the San Francisco underserved

Briton Lee et al. Autoimmunity. 2018 Aug.

Abstract

Although autoimmune hepatitis (AIH) is more common in women and affects people of all races/ethnicities, there is currently limited information regarding the relationship between race/ethnicity and AIH, especially in the context of underserved populations. We aim to evaluate the relationship between race/ethnicity and AIH and better characterize its clinical features among different racial groups. We conducted a 15-year retrospective analysis, from January 2002 to June 2017, of patients seen at Zuckerberg San Francisco General Hospital (ZSFG). Sixty-three AIH patients and 2049 non-AIH controls were eligible for the study. The main predictor of interest was race/ethnicity, and the main outcome of interest was AIH diagnosis; other secondary measures recorded include clinical features such as ALT, bilirubin, and biopsy fibrosis at presentation. In a multivariable model adjusting for age and sex, we found that black (OR 9.6, 95% CI 1.8-178), Latino (OR 25.0, 95% CI 5.3-448), and Asian/Pacific Islander (API) (OR 10.8, 95% CI 2.2-196) race/ethnicity were associated with increased odds of an AIH diagnosis compared to the white reference group. Among people of colour with AIH, there were no significant differences in baseline ALT (p = .45), total bilirubin at presentation (p = .06), fibrosis at presentation (p = .74), and hospitalization (p = .27). Race/ethnicity is an independent risk factor for AIH. The clinical features of AIH did not differ significantly among black, Latino, and API patients.

Keywords: Autoimmune liver disease; liver; liver fibrosis; outcomes research; race/ethnicity.

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Figures

Fig. 1.
Fig. 1.
ALT at time of diagnosis and at 6 months after treatment for black, Latino, and API AIH patients (n = 52). White and other patients not shown due to small numbers. Boxplot shows 1st quartile, median, and 3rd quartile, while the lines represent the range of values excluding outliers.
Fig. 2.
Fig. 2.
Total bilirubin at time of diagnosis for black (n = 8), Latino (n = 28) and API (n = 16) patients with AIH. Boxplot as in Fig. 1.
Fig. 3.
Fig. 3.
Biopsy data showing inflammation grade (n = 35) and fibrosis stage (n = 44) for black, Latino, and API AIH patients. Individual patients’ values are overlaid on top of the box plots. Boxplot as in Fig. 1.
Fig. 4.
Fig. 4.
Time-to-event analysis comparing duration of steroid treatment for black, Latino, and API patients with AIH (p = 1).
See this image and copyright information in PMC

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