Primary Biliary Cirrhosis: Environmental Risk Factors

Dronamraju, Deepti; Odin, Joseph A.; Bach, Nancy

doi:10.1155/2010/834926

Cited by 8 publications

(5 citation statements)

References 33 publications

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“…Xenobiotics have also been implicated in the etiology of PBC. These commonly occur in pollutants, food preservatives, and pesticides 26. Atmospheric concentrations of pollutants are known to exhibit seasonal variation, providing support for a possible link with the onset of PBC 27, 28.…”

Section: Discussionmentioning

confidence: 95%

Seasonal variation in the patient diagnosis of primary biliary cirrhosis: Further evidence for an environmental component to etiology

et al. 2011

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The etiology of primary biliary cirrhosis (PBC) is far from clear. Both genetic and environmental factors are likely to be involved. We have previously reported evidence of space-time clustering, suggesting that a transient environmental agent may be involved in etiology. To further examine whether a seasonally varying environmental agent may contribute to the etiology of PBC, we have analyzed seasonal variation with respect to month of diagnosis using population-based data from northeast England over a defined period (1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003). Date of diagnosis was defined as the earliest date at which the patient was found to have fulfilled any two of three diagnostic criteria (i.e., antimitochondrial antibody-positive titer 1 in 40, cholestatic liver blood tests, diagnostic or compatible liver histology). Monthly expected (E) numbers of cases were calculated under an assumption of a uniform distribution throughout the year. Observed counts (O) were compared with the expected numbers. The chi-squared heterogeneity test was used to test for overall nonuniform variation and also for individual months. Poisson regression analysis was used to fit a sinusoidal (i.e., harmonic) model to the data, using month of diagnosis as a covariate in the model. There was a marked peak for diagnoses in the month of June (O 5 115, E 5 84.7, O/E 5 1.36; P 5 0.001). Furthermore, there was evidence of a sinusoidal pattern with a June peak (P 5 0.012). Conclusion: These highly novel results provide further evidence for the involvement of a seasonally varying environmental agent in the etiology of PBC.

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Section: Discussionmentioning

confidence: 95%

Seasonal variation in the patient diagnosis of primary biliary cirrhosis: Further evidence for an environmental component to etiology

et al. 2011

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“…These include infections such as Mycobacterium gordonae , Escherichia coli , and Novosphingobium aromaticivorans (29–41). Other environmental factors that may display spatial variation include xenobiotics, which are present in pollutants (10). Lifestyle factors may also vary by social community and residential area.…”

Section: Discussionmentioning

confidence: 99%

“…This finding suggested that one or more spatially heterogeneous environmental agents may play a role in the etiology of PBC. Putative agents include infections, smoking, hair dyes, and xenobiotics (4, 7–10). …”

mentioning

confidence: 99%

No Rise in Incidence but Geographical Heterogeneity in the Occurrence of Primary Biliary Cirrhosis in North East England

McNally

James²,

Ducker³

et al. 2014

American Journal of Epidemiology

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In this study, we examined temporal changes in the incidence of primary biliary cirrhosis (PBC) and investigated associations between PBC incidence and sociodemographic factors and spatial clustering. We included 982 patients aged ≥40 years from North East England with incident PBC diagnosed during 1987–2003. Age-standardized incidence rates with 95% confidence intervals were calculated. Negative binomial regression was used to analyze incidence and socioeconomic deprivation. Clustering analysis was performed using point process methods, testing the null hypothesis that disease risk does not vary spatially and that PBC cases occur independently. The age-standardized incidence rate was 53.50 per million persons per year (95% confidence interval: 48.65, 58.35) in 1987–1994 and 45.09 per million persons per year (95% confidence interval: 41.10, 49.07) in 1995–2003. Risk of PBC increased in areas with higher levels of socioeconomic deprivation (P = 0.035). More specifically, risk increased in areas with higher levels of overcrowded homes (P = 0.040), higher levels of households without cars (P < 0.001), and higher levels of non-owner-occupied homes (P < 0.001). Overall, there was evidence of spatial clustering (P = 0.001). The findings confirm that overall incidence of PBC did not rise over time, but sociodemographic variations suggest that certain aspects of deprivation are involved in its etiology.

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“…A similar mechanism has been proposed for childhood precursor B-cell acute lymphoblastic leukaemia (Greaves, 1988). Possible infectious agents, indicated by other studies, include E. coli, Novosphingobium aromaticivorans, mycobacteria and human beta retrovirus (Butler et al, 1993(Butler et al, , 1995Haydon and Neuberger, 2000;Shimoda et al, 2000;Tsuneyama et al, 2001;Selmi et al, 2003;Xu et al, 2003;Kaplan, 2004;Olafsson et al, 2004; Possible non-infectious agents include xenobiotics that commonly occur in pollutants, food preservatives and pesticides (Dronamraju et al, 2010), as well as past or present smoking and previous pregnancies (Selmi et al, 2011). Whilst some of these factors suggest a long latency for the onset of clinical disease, the potential role of infectious agents -together with the seasonal pattern reported previously (McNally et al, 2011) -suggest that the latency may be short for certain risk factors.…”

Section: Type Of Analysis Time Period Within Months Within Quarters Wmentioning

confidence: 72%

Does primary biliary cirrhosis cluster in time?

Muirhead

James

Ducker

et al. 2015

Spatial and Spatio-temporal Epidemiology

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The aetiology of primary biliary cirrhosis (PBC) is not well established. Previously we found evidence of space-time clustering and seasonal variation in the date of diagnosis, suggesting a possible role for a transient or seasonally varying environmental factor. We examined whether a temporally varying environmental agent may be involved by analysing population-based PBC data from northeast England over 1987-2003. Using an adaptation of a method proposed by Potthoff and Whittinghill, we found significant temporal variation by date of diagnosis at the level of aggregation of one year. However, there was no evidence for general irregular (non-seasonal) temporal clustering within periods less than a year. These results provide little support for the involvement of agents occurring in geographically widespread mini-epidemics, but--taken together with studies of spatial and spatio-temporal clustering--do not preclude the role of more localised sporadic mini-epidemics. Future research should seek to elicit putative environmental agents.

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Primary Biliary Cirrhosis: Environmental Risk Factors

Cited by 8 publications

References 33 publications

Seasonal variation in the patient diagnosis of primary biliary cirrhosis: Further evidence for an environmental component to etiology

Seasonal variation in the patient diagnosis of primary biliary cirrhosis: Further evidence for an environmental component to etiology

No Rise in Incidence but Geographical Heterogeneity in the Occurrence of Primary Biliary Cirrhosis in North East England

Does primary biliary cirrhosis cluster in time?

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