Global Epidemiology of Primary Biliary Cholangitis: An Updated Systematic Review and Meta-analysis

Abstract

Background & aims: Primary biliary cholangitis (PBC) demonstrates significant geographical variability in its epidemiology. We aim to provide an updated estimate on the global and temporal trends of the prevalence and incidence of PBC from 1976 to 2024.

Methods: We systematically searched three electronic databases from inception to August 20, 2024, to include all studies reporting the incidence or prevalence of PBC. The outcomes of interest were the prevalence and incidence of PBC. Subgroup analysis was performed by study type, study period, geographical region, sex, Human Development Index, method of diagnosis, and latitude. The temporal trend of PBC prevalence and incidence was analyzed using meta-regression. The study protocol was registered with PROSPERO (CRD42024595102).

Results: A total of 59 studies, encompassing 381 million participants and 129,455 patients with PBC across 25 countries were included. The pooled global prevalence of PBC was 18.1 cases per 100,000 people (95% confidence interval, 14.6-22.0; I² = 99.9%; 55 studies) among population-based studies with low risk of bias. The incidence rate of PBC was 1.8 per 100,000 person-years (95% confidence interval, 1.5-2.3; I² = 99.6%; 46 studies). PBC prevalence was higher in countries with higher latitude, higher Human Development Index, in America and among the female sex. Global prevalence of PBC has increased over time, with the Western Pacific region experiencing the greatest rise in PBC prevalence over time.

Conclusion: The rising prevalence of PBC represents a growing healthcare burden in Western Pacific region. The association between latitude and PBC prevalence requires further studies.

Keywords: Epidemiology; Incidence; Meta-analysis; Prevalence; Primary Biliary Cholangitis.