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Lookup NU author(s): Dr Jess Dyson, Dr Alasdair Blain, Dr Mark Hudson, Professor Stephen Rushton, Professor David Jones
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).
© 2020 The Authors. 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.
Author(s): Dyson JK, Blain A, Foster Shirley MD, Hudson M, Rushton S, Jones DEJ
Publication type: Article
Publication status: Published
Journal: JHEP Reports
Year: 2021
Volume: 3
Issue: 1
Print publication date: 01/02/2021
Online publication date: 04/11/2020
Acceptance date: 09/10/2020
Date deposited: 19/09/2024
ISSN (electronic): 2589-5559
Publisher: Elsevier BV
URL: https://doi.org/10.1016/j.jhepr.2020.100202
DOI: 10.1016/j.jhepr.2020.100202
Data Access Statement: Owing to the detailed geographical information collected about patients, participants were assured that raw data would remain confidential and would not be shared.
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