Incidence, prevalence and mortality of autoimmune hepatitis in England 1997-2015. A population-based cohort study.
autoimmune
cohort study
epidemiology
hepatitis
incidence
prevalence
prognosis
registry
Journal
Liver international : official journal of the International Association for the Study of the Liver
ISSN: 1478-3231
Titre abrégé: Liver Int
Pays: United States
ID NLM: 101160857
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
received:
20
11
2019
revised:
06
04
2020
accepted:
13
04
2020
pubmed:
19
4
2020
medline:
22
6
2021
entrez:
19
4
2020
Statut:
ppublish
Résumé
There are few population-based studies of the incidence and mortality of autoimmune hepatitis. The burden of the disease and how it has changed over time have not been fully explored. We conducted a population-based cohort study on the incidence and mortality of autoimmune hepatitis in England, 1997-2015. From the Clinical Practice Research Datalink we included 882 patients diagnosed with autoimmune hepatitis in England, 1997-2015. The patients were followed through 2015, and we calculated the sex- and age-standardized incidence and prevalence of autoimmune hepatitis. We examined variation in incidence by sex, age, calendar year, geographical region and socioeconomic status, and incidence rate ratios were calculated with Poisson regression. We calculated all-cause and cause-specific mortality. The overall standardized incidence rate of autoimmune hepatitis was 2.08 (95% confidence interval 1.94-2.22) per 100,000 population per year, higher in women, higher in older age and independent of region and socioeconomic status. From 1997 to 2015 the incidence doubled from 1.27 (95% confidence interval 0.51-2.02) to 2.56 (95% confidence interval 1.79-3.33) per 100,000 population per year. The 10-year cumulative all-cause mortality was 31.9% (95% confidence interval 27.6-36.5), and the 10-year cumulative liver-related mortality, including hepatocellular carcinoma was ~10.5%. This population-based study showed that the incidence of autoimmune hepatitis doubled over an eighteen-year period. The incidence was particularly high in older women and was similar across all regions of England and independent of socioeconomic status. Patients with autoimmune hepatitis had a high mortality.
Sections du résumé
BACKGROUND & AIMS
There are few population-based studies of the incidence and mortality of autoimmune hepatitis. The burden of the disease and how it has changed over time have not been fully explored. We conducted a population-based cohort study on the incidence and mortality of autoimmune hepatitis in England, 1997-2015.
METHODS
From the Clinical Practice Research Datalink we included 882 patients diagnosed with autoimmune hepatitis in England, 1997-2015. The patients were followed through 2015, and we calculated the sex- and age-standardized incidence and prevalence of autoimmune hepatitis. We examined variation in incidence by sex, age, calendar year, geographical region and socioeconomic status, and incidence rate ratios were calculated with Poisson regression. We calculated all-cause and cause-specific mortality.
RESULTS
The overall standardized incidence rate of autoimmune hepatitis was 2.08 (95% confidence interval 1.94-2.22) per 100,000 population per year, higher in women, higher in older age and independent of region and socioeconomic status. From 1997 to 2015 the incidence doubled from 1.27 (95% confidence interval 0.51-2.02) to 2.56 (95% confidence interval 1.79-3.33) per 100,000 population per year. The 10-year cumulative all-cause mortality was 31.9% (95% confidence interval 27.6-36.5), and the 10-year cumulative liver-related mortality, including hepatocellular carcinoma was ~10.5%.
CONCLUSIONS
This population-based study showed that the incidence of autoimmune hepatitis doubled over an eighteen-year period. The incidence was particularly high in older women and was similar across all regions of England and independent of socioeconomic status. Patients with autoimmune hepatitis had a high mortality.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1634-1644Informations de copyright
© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Références
Manns MP, Lohse AW, Vergani D. Autoimmune hepatitis - update 2015. J Hepatol. 2015;62(1S):S100-S111.
Grønbaek L, Vilstrup H, Pedersen L, Christensen K, Jepsen P. Family occurrence of autoimmune hepatitis: a Danish nationwide registry-based cohort study. J Hepatol. 2018;69(4):873-877.
Yoshizawa K, Joshita S, Matsumoto A, et al. Incidence and prevalence of autoimmune hepatitis in the Ueda area, Japan. Hepatol Res. 2015;46(9):848-852.
Jepsen P, Grønbaek L, Vilstrup H. Worldwide incidence of autoimmune liver disease. Dig Dis. 2015;33(Suppl 2):2-12.
Danielsson Borssén Å, Marschall H-U, Bergquist A, et al. Epidemiology and causes of death in a Swedish cohort of patients with autoimmune hepatitis. Scand J Gastroenterol. 2017;52(9):1022-1028.
Valgeirsson KB, Hreinsson JP, Bjornsson ES. Increased incidence of autoimmune hepatitis is associated with wider use of biological drugs. Liver Int. 2019;39(12):2341-2349.
Puustinen L, Barner-Rasmussen N, Pukkala E, Farkkila M. Incidence, prevalence, and causes of death of patients with autoimmune hepatitis: a nationwide register-based cohort study in Finland. Dig Liver Dis. 2019;51(9):1294-1299.
Ngu JH, Bechly K, Chapman BA, et al. Population-based epidemiology study of autoimmune hepatitis: a disease of older women?J Gastroenterol Hepatol. 2010;25(10):1681-1686.
Tanner AR, Dellipiani AW. Chronic active hepatitis: a sixteen year survey at a district general hospital. Postgrad Med J. 1989;65(768):725-728.
Werner M, Prytz H, Ohlsson B, et al. Epidemiology and the initial presentation of autoimmune hepatitis in Sweden: a nationwide study. Scand J Gastroenterol. 2008;43(10):1232-1240.
Boberg KM, Aadland E, Jahnsen J, Raknerud N, Stiris M, Bell H. Incidence and prevalence of primary biliary cirrhosis, primary sclerosing cholangitis, and autoimmune hepatitis in a Norwegian population. Scand J Gastroenterol. 1998;33(1):99-103.
Primo J, Merino C, Fernandez J, Moles JR, Llorca P, Hinojosa J. Incidence and prevalence of autoimmune hepatitis in the area of the Hospital de Sagunto (Spain). Gastroenterol Hepatol. 2004;27(4):239-243.
vanGerven NMF, Verwer BJ, Witte BI, et al. Epidemiology and clinical characteristics of autoimmune hepatitis in the Netherlands. Scand J Gastroenterol. 2014;49(10):1245-1254.
Grønbaek L, Vilstrup H, Jepsen P. Autoimmune hepatitis in Denmark: incidence, prevalence, prognosis, and causes of death. A nationwide registry-based cohort study. J Hepatol. 2014;60(3):612-617.
Pan H-Y, Dai Y-N, Zheng J-N, et al. National incidence of autoimmune liver diseases and its relationship with the human development index. Oncotarget. 2016;7(29):46273-46282.
Ngu JH, Gearry RB, Frampton CM, Stedman CA. Autoimmune hepatitis: the role of environmental risk factors: a population-based study. Hepatol Int. 2013;7(3):869-875.
Cook GC, Mulligan R, Sherlock S. Controlled prospective trial of corticosteroid therapy in active chronic hepatitis. Q J Med. 1971;40(158):159-185.
Feld JJ, Dinh H, Arenovich T, Marcus VA, Wanless IR, Heathcote EJ. Autoimmune hepatitis: effect of symptoms and cirrhosis on natural history and outcome. Hepatology. 2005;42(1):53-62.
Landeira G, Morise S, Fassio E, et al. Effect of cirrhosis at baseline on the outcome of type 1 autoimmune hepatitis. Ann Hepatol. 2012;11(1):100-106.
Ngu JH, Gearry RB, Frampton CM, Stedman CA. Mortality and the risk of malignancy in autoimmune liver diseases: a population-based study in Canterbury, New Zealand. Hepatology. 2012;55(2):522-529.
van denBrand FF, van derVeen KS, deBoer YS, et al. Increased mortality among patients with vs without cirrhosis and autoimmune hepatitis. Clin Gastroenterol Hepatol. 2018.
Werner M, Wallerstedt S, Lindgren S, et al. Characteristics and long-term outcome of patients with autoimmune hepatitis related to the initial treatment response. Scand J Gastroenterol. 2010;45(4):457-467.
Hoeroldt B, McFarlane E, Dube A, et al. Long-term outcomes of patients with autoimmune hepatitis managed at a nontransplant center. Gastroenterology. 2011;140(7):1980-1989.
Kirstein MM, Metzler F, Geiger E, et al. Prediction of short- and long-term outcome in patients with autoimmune hepatitis. Hepatology. 2015.
Malekzadeh Z, Haghazali S, Sepanlou SG, et al. Clinical features and long term outcome of 102 treated autoimmune hepatitis patients. Hepat Mon. 2012;12(2):92-99.
Roberts SK, Therneau TM, Czaja AJ. Prognosis of histological cirrhosis in type 1 autoimmune hepatitis. Gastroenterology. 1996;110(3):848-857.
Migita K, Watanabe Y, Jiuchi Y, et al. Hepatocellular carcinoma and survival in patients with autoimmune hepatitis (Japanese National Hospital Organization-autoimmune hepatitis prospective study). Liver Int. 2012;32(5):837-844.
Yoshizawa K, Matsumoto A, Ichijo T, et al. Long-term outcome of Japanese patients with type 1 autoimmune hepatitis. Hepatology. 2012;56(2):668-676.
Dhaliwal HK, Hoeroldt BS, Dube AK, et al. Long-term prognostic significance of persisting histological activity despite biochemical remission in autoimmune hepatitis. Am J Gastroenterol. 2015;110(7):993-999.
Herrett E, Gallagher AM, Bhaskaran K, et al. Data resource profile: clinical practice research datalink (CPRD). Int J Epidemiol. 2015;44(3):827-836.
Ministry of Housing CLG, UK. https://www.gov.uk/government/statistics/english-indices-of-deprivation-2015. 2015. Accessed September 30, 2015.
Strong M, Maheswaran R, Pearson T. A comparison of methods for calculating general practice level socioeconomic deprivation. Int J Health Geogr. 2006;5:29.
Office for National Statistics U. 2017. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/methodologies/userguidetomortalitystatisticsjuly2017. Accessed April 27, 2020.
Lewis JD, Bilker WB, Weinstein RB, Strom BL. The relationship between time since registration and measured incidence rates in the General Practice Research Database. Pharmacoepidemiol Drug Saf. 2005;14(7):443-451.
Eurostat. https://ec.europa.eu/eurostat/documents/3859598/5926869/KS-RA-13-028-EN.PDF/e713fa79-1add-44e8-b23d-5e8fa09b3f8f. Accessed April 27, 2020.
Jepsen P, Vilstrup H, Andersen PK. The clinical course of cirrhosis: The importance of multistate models and competing risks analysis. Hepatology. 2015;62(1):292-302.
Khan NF, Harrison SE, Rose PW. Validity of diagnostic coding within the General Practice Research Database: a systematic review. Br J Gen Pract. 2010;60(572):e128-e136.
Herrett E, Thomas SL, Schoonen WM, Smeeth L, Hall AJ. Validation and validity of diagnoses in the General Practice Research Database: a systematic review. Br J Clin Pharmacol. 2010;69(1):4-14.
Alvarez F, Berg PA, Bianchi FB, et al. International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol. 1999;31(5):929-938.
Hennes EM, Zeniya M, Czaja AJ, et al. Simplified criteria for the diagnosis of autoimmune hepatitis. Hepatology. 2008;48(1):169-176.
Varyani F, Card T, Kaye P, Aithal GP, West J. The communication of a secondary care diagnosis of autoimmune hepatitis to primary care practitioners: a population-based study. BMC Health Serv Res. 2013;13:161.
Al-Chalabi T, Boccato S, Portmann BC, McFarlane IG, Heneghan MA. Autoimmune hepatitis (AIH) in the elderly: a systematic retrospective analysis of a large group of consecutive patients with definite AIH followed at a tertiary referral centre. J Hepatol. 2006;45(4):575-583.
Parker DR, Kingham JG. Type I autoimmune hepatitis is primarily a disease of later life. QJM. 1997;90(4):289-296.
Hodges JR, Millward-Sadler GH, Wright R. Chronic active hepatitis: the spectrum of disease. Lancet. 1982;1(8271):550-552.
Schramm C, Kanzler S, Meyer zum Buschenfelde K-H, et al. Autoimmune hepatitis in the elderly. Am J Gastroenterol. 2001;96(5):1587-1591.
Ritland S. The incidence of chronic active hepatitis in Norway. A retrospective study. Scand J Gastroenterol. 1985;107:58-60.
Lee YM, Teo EK, Ng TM, Khor C, Fock KM. Autoimmune hepatitis in Singapore: a rare syndrome affecting middle-aged women. J Gastroenterol Hepatol. 2001;16(12):1384-1389.
Muratori P, Granito A, Quarneti C, et al. Autoimmune hepatitis in Italy: the Bologna experience. J Hepatol. 2009;50(6):1210-1218.
Ngu JH, Gearry RB, Frampton CM, Stedman CA. Predictors of poor outcome in patients with autoimmune hepatitis: a population-based study. Hepatology. 2013;57(3):2399-2406.
Wakefield J. Ecologic studies revisited. Annu Rev Public Health. 2008;29:75-90.
Whalley S, Puvanachandra P, Desai A, Kennedy H. Hepatology outpatient service provision in secondary care: a study of liver disease incidence and resource costs. Clin Med (Lond). 2007;7(2):119-124.
Lerner A, Jeremias P, Matthias T. The world incidence and prevalence of autoimmune diseases is increasing. Int J Celiac Dis. 2015;3(4):151-155.
Card TR, Solaymani-Dodaran M, West J. Incidence and mortality of primary sclerosing cholangitis in the UK: a population-based cohort study. J Hepatol. 2008;48(6):939-944.
Partington RJ, Muller S, Helliwell T, Mallen CD, Abdul SA. Incidence, prevalence and treatment burden of polymyalgia rheumatica in the UK over two decades: a population-based study. Ann Rheum Dis. 2018;77(12):1750-1756.
West J, Otete H, Sultan AA, Crooks CJ. Changes in testing for and incidence of celiac disease in the United Kingdom: a population-based cohort study. Epidemiology. 2019;30(4):e23-e24.
West J, Fleming KM, Tata LJ, Card TR, Crooks CJ. Incidence and prevalence of celiac disease and dermatitis herpetiformis in the UK over two decades: population-based study. Am J Gastroenterol. 2014;109(5):757-768.
Floreani A, Restrepo-Jiménez P, Secchi MF, et al. Etiopathogenesis of autoimmune hepatitis. J Autoimmun. 2018;95:133-143.
Jyrkka J, Vartiainen L, Hartikainen S, Sulkava R, Enlund H. Increasing use of medicines in elderly persons: a five-year follow-up of the Kuopio 75+Study. Eur J Clin Pharmacol. 2006;62(2):151-158.
Lash TL, Cole SR. Immortal person-time in studies of cancer outcomes. J Clin Oncol. 2009;27(23):e55-e56.
Romeri E, Baker A, Griffiths C. Mortality by deprivation and cause of death in England and Wales, 1999-2003. Health Stat Q. 2006;32:19-34.
Kanzler S, Lohr H, Gerken G, Galle PR, Lohse AW. Long-term management and prognosis of autoimmune hepatitis (AIH): a single center experience. Z Gastroenterol. 2001;39(5):339-348.
National Health Service U. https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/12250/nhsbt-liver-transplantation-annual-report-2017-2018.pdf. Accessed May 15, 2019.