Liver Failure and Liver Disease
Risk factors and comorbidities in primary biliary cirrhosis: A controlled interview-based study of 1032 patients†
Article first published online: 25 OCT 2005
Copyright © 2005 American Association for the Study of Liver Diseases
Volume 42, Issue 5, pages 1194–1202, November 2005
How to Cite
Gershwin, M. E., Selmi, C., Worman, H. J., Gold, E. B., Watnik, M., Utts, J., Lindor, K. D., Kaplan, M. M. and Vierling, J. M. (2005), Risk factors and comorbidities in primary biliary cirrhosis: A controlled interview-based study of 1032 patients. Hepatology, 42: 1194–1202. doi: 10.1002/hep.20907
Potential conflict of interest: Nothing to report.
Members of the USA PBC Epidemiology Group are listed in the Acknowledgments.
- Issue published online: 25 OCT 2005
- Article first published online: 25 OCT 2005
- Manuscript Accepted: 18 AUG 2005
- Manuscript Received: 19 JUL 2005
- NIH. Grant Number: DK56839
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. (HEPATOLOGY 2005;42:1194–1202.)