Race/ethnicity is an independent risk factor for autoimmune hepatitis among the San Francisco underserved

Abstract

Although autoimmune hepatitis (AIH) is more common in women and affects people of all races/ethnicities, there is currently limited information regarding the relationship between race/ethnicity and AIH, especially in the context of underserved populations. We aim to evaluate the relationship between race/ethnicity and AIH and better characterize its clinical features among different racial groups. We conducted a 15-year retrospective analysis, from January 2002 to June 2017, of patients seen at Zuckerberg San Francisco General Hospital (ZSFG). Sixty-three AIH patients and 2049 non-AIH controls were eligible for the study. The main predictor of interest was race/ethnicity, and the main outcome of interest was AIH diagnosis; other secondary measures recorded include clinical features such as ALT, bilirubin, and biopsy fibrosis at presentation. In a multivariable model adjusting for age and sex, we found that black (OR 9.6, 95% CI 1.8–178), Latino (OR 25.0, 95% CI 5.3–448), and Asian/Pacific Islander (API) (OR 10.8, 95% CI 2.2–196) race/ethnicity were associated with increased odds of an AIH diagnosis compared to the white reference group. Among people of colour with AIH, there were no significant differences in baseline ALT (p = .45), total bilirubin at presentation (p = .06), fibrosis at presentation (p = .74), and hospitalization (p = .27). Race/ethnicity is an independent risk factor for AIH. The clinical features of AIH did not differ significantly among black, Latino, and API patients.

Keywords:

• Autoimmune liver disease
• liver
• outcomes research
• liver fibrosis
• race/ethnicity

Acknowledgements

The authors would like to acknowledge the UCSF Clinical and Translational Sciences Institute/Academic Research Systems, REDCap, Michael Kohn, J.P. Grenert, Jason Wen, Jennifer Price, Jill Barr-Walker, Marion Peters, and Norah Terrault.

Data availability: Data are stored on UCSF’s REDCap database.

Disclosure statement

Author’s declaration of personal interests: M.K. – Gilead Inc. (consulting, advisory arrangements), Intercept Pharmaceuticals (advisory arrangements); R.W.– Gilead Inc. (consulting, advisory arrangements, speakers’ bureau, research). This project was not directly funded by any organization.

Additional information

Funding

This work was supported by the UCSF Liver Center under Grant P30DK026743; Dr. Mandana Khalili is supported by National Institutes of Health under Grant Number K24AA022523.