Geo-epidemiology and environmental co-variate mapping of primary biliary cholangitis and primary sclerosing cholangitis
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...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2021-02-01
|
| Series: | JHEP Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589555920301361 |
| _version_ | 1818920367229501440 |
|---|---|
| author | Jessica Katharine Dyson Alasdair Blain Mark David Foster Shirley Mark Hudson Steven Rushton David Emrys Jeffreys Jones |
| author_facet | Jessica Katharine Dyson Alasdair Blain Mark David Foster Shirley Mark Hudson Steven Rushton David Emrys Jeffreys Jones |
| author_sort | Jessica Katharine Dyson |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-20T01:20:37Z |
| format | Article |
| id | doaj.art-48c699a4291c460989c489a2087e65e4 |
| institution | Directory Open Access Journal |
| issn | 2589-5559 |
| language | English |
| last_indexed | 2024-12-20T01:20:37Z |
| publishDate | 2021-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JHEP Reports |
| spelling | doaj.art-48c699a4291c460989c489a2087e65e42022-12-21T19:58:27ZengElsevierJHEP Reports2589-55592021-02-0131100202Geo-epidemiology and environmental co-variate mapping of primary biliary cholangitis and primary sclerosing cholangitisJessica Katharine Dyson0Alasdair Blain1Mark David Foster Shirley2Mark Hudson3Steven Rushton4David Emrys Jeffreys Jones5Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK; Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK; Corresponding author. Address: Liver Unit, Freeman Hospital, High Heaton, Newcastle-upon-Tyne, England, UK, NE7 7DN. Tel.: +44 191 244 8606.Wellcome Centre for Mitochondrial Research, Newcastle University, Newcastle-upon-Tyne, UKSchool of Natural and Environmental Sciences, Newcastle University, Newcastle-upon-Tyne, UKTranslational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK; Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UKSchool of Natural and Environmental Sciences, Newcastle University, Newcastle-upon-Tyne, UKTranslational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK; Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UKBackground & 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.http://www.sciencedirect.com/science/article/pii/S2589555920301361Primary biliary cholangitisPrimary sclerosing cholangitisAutoimmune hepatitisGeo-epidemiologySocio-economic statusCadmium |
| spellingShingle | Jessica Katharine Dyson Alasdair Blain Mark David Foster Shirley Mark Hudson Steven Rushton David Emrys Jeffreys Jones Geo-epidemiology and environmental co-variate mapping of primary biliary cholangitis and primary sclerosing cholangitis JHEP Reports Primary biliary cholangitis Primary sclerosing cholangitis Autoimmune hepatitis Geo-epidemiology Socio-economic status Cadmium |
| title | Geo-epidemiology and environmental co-variate mapping of primary biliary cholangitis and primary sclerosing cholangitis |
| title_full | Geo-epidemiology and environmental co-variate mapping of primary biliary cholangitis and primary sclerosing cholangitis |
| title_fullStr | Geo-epidemiology and environmental co-variate mapping of primary biliary cholangitis and primary sclerosing cholangitis |
| title_full_unstemmed | Geo-epidemiology and environmental co-variate mapping of primary biliary cholangitis and primary sclerosing cholangitis |
| title_short | Geo-epidemiology and environmental co-variate mapping of primary biliary cholangitis and primary sclerosing cholangitis |
| title_sort | geo epidemiology and environmental co variate mapping of primary biliary cholangitis and primary sclerosing cholangitis |
| topic | Primary biliary cholangitis Primary sclerosing cholangitis Autoimmune hepatitis Geo-epidemiology Socio-economic status Cadmium |
| url | http://www.sciencedirect.com/science/article/pii/S2589555920301361 |
| work_keys_str_mv | AT jessicakatharinedyson geoepidemiologyandenvironmentalcovariatemappingofprimarybiliarycholangitisandprimarysclerosingcholangitis AT alasdairblain geoepidemiologyandenvironmentalcovariatemappingofprimarybiliarycholangitisandprimarysclerosingcholangitis AT markdavidfostershirley geoepidemiologyandenvironmentalcovariatemappingofprimarybiliarycholangitisandprimarysclerosingcholangitis AT markhudson geoepidemiologyandenvironmentalcovariatemappingofprimarybiliarycholangitisandprimarysclerosingcholangitis AT stevenrushton geoepidemiologyandenvironmentalcovariatemappingofprimarybiliarycholangitisandprimarysclerosingcholangitis AT davidemrysjeffreysjones geoepidemiologyandenvironmentalcovariatemappingofprimarybiliarycholangitisandprimarysclerosingcholangitis |