Environmental exposures are important risk factors for advanced liver fibrosis in African American adults.
Environmental exposures are important risk factors for advanced liver fibrosis in African American adults.
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DOI：
10.1016/j.jhepr.2023.100696
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发表时间：
2023-04
期刊：
影响因子：
8.3
通讯作者：
Branch, Andrea D.
中科院分区：
文献类型：
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作者：
Ma, Ning;Yip, Rowena;Lewis, Sara;Dinani, Amreen;Wyatt, Christina;Crane, Michael;Jirapatnakul, Artit;Li, Li;Aloman, Costica;Bansal, Meena B.;Dieterich, Douglas;Wyatt, Brooke;Yankelevitz, David;Henschke, Claudia;Branch, Andrea D.
肝纤维化的患病率和病因随时间而变化，对种族/民族的影响也不均匀。这项研究测量了美国晚期肝纤维化的时间趋势，并确定了与晚期肝纤维化相关的因素。采用标准化方法分析1999-2018年全国健康与营养调查（National Health and Nutrition Examination Survey） 47422名参与者（≥20岁）的数据。晚期肝纤维化定义为纤维化-4≥2.67和/或Forns指数≥6.9和谷丙转氨酶升高。晚期肝纤维化患者的估计数量从130万（95% CI 0.8-1.9）增加到350万（95% CI 2.8-4.2），增加了近三倍。非西班牙裔黑人和墨西哥裔美国人的患病率高于非西班牙裔白人。在多变量logistic回归分析中，镉是所有种族/民族的独立危险因素。吸烟和目前过度饮酒是大多数患者的危险因素。重要的是，与非西班牙裔白人相比，非西班牙裔黑人有一系列独特的危险因素，包括贫困（比值比[OR] 2.09; 95% CI 1.44-3.03）和铅暴露易感性（OR 3.25; 95% CI 1.95-5.43），但不包括糖尿病（OR 0.88; 95% CI 0.61-1.27; p =0.52）。非西班牙裔黑人比非西班牙裔白人更容易接触到铅、镉、多氯联苯和贫困。晚期肝纤维化患者的数量有所增加，需要扩大肝脏护理队伍。晚期纤维化的危险因素因种族而异。这些差异为设计筛查方案提供了有用的信息。贫困和有毒物质暴露与非西班牙裔黑人中晚期肝纤维化的高发率有关，需要加以解决。由于肝病通常很少产生警告信号，因此需要由非专业人员进行简单而廉价的筛查测试，以便及时诊断并与护理联系起来。这项研究表明，非西班牙裔黑人在设计肝病筛查方案时需要考虑到一系列独特的风险因素。暴露于外源性毒素可能是非西班牙裔黑人晚期肝纤维化的特别重要的危险因素。在过去的20年里，美国晚期肝纤维化的发病率翻了一番。非西班牙裔黑人的患病率高于非西班牙裔白人。非西班牙裔黑人的危险因素包括铅暴露，但不包括糖尿病。镉在所有被调查的种族/民族群体中都是一个危险因素。
The prevalence and aetiology of liver fibrosis vary over time and impact racial/ethnic groups unevenly. This study measured time trends and identified factors associated with advanced liver fibrosis in the United States. Standardised methods were used to analyse data on 47,422 participants (≥20 years old) in the National Health and Nutrition Examination Survey (1999–2018). Advanced liver fibrosis was defined as Fibrosis-4 ≥2.67 and/or Forns index ≥6.9 and elevated alanine aminotransferase. The estimated number of people with advanced liver fibrosis increased from 1.3 million (95% CI 0.8–1.9) to 3.5 million (95% CI 2.8–4.2), a nearly threefold increase. Prevalence was higher in non-Hispanic Black and Mexican American persons than in non-Hispanic White persons. In multivariable logistic regression analysis, cadmium was an independent risk factor in all racial/ethnic groups. Smoking and current excessive alcohol use were risk factors in most. Importantly, compared with non-Hispanic White persons, non-Hispanic Black persons had a distinctive set of risk factors that included poverty (odds ratio [OR] 2.09; 95% CI 1.44–3.03) and susceptibility to lead exposure (OR 3.25; 95% CI 1.95–5.43) but did not include diabetes (OR 0.88; 95% CI 0.61–1.27; p =0.52). Non-Hispanic Black persons were more likely to have high exposure to lead, cadmium, polychlorinated biphenyls, and poverty than non-Hispanic White persons. The number of people with advanced liver fibrosis has increased, creating a need to expand the liver care workforce. The risk factors for advanced fibrosis vary by race/ethnicity. These differences provide useful information for designing screening programmes. Poverty and toxic exposures were associated with the high prevalence of advanced liver fibrosis in non-Hispanic Black persons and need to be addressed. Because liver disease often produces few warning signs, simple and inexpensive screening tests that can be performed by non-specialists are needed to allow timely diagnosis and linkage to care. This study shows that non-Hispanic Black persons have a distinctive set of risk factors that need to be taken into account when designing liver disease screening programs. Exposure to exogenous toxins may be especially important risk factors for advanced liver fibrosis in non-Hispanic Black persons. The prevalence of advanced liver fibrosis doubled in the past 20 years in the United States. Prevalence was higher in non-Hispanic Black persons than in non-Hispanic White persons. Risk factors in non-Hispanic Black persons included lead exposure, but not diabetes. Cadmium was a risk factor in all racial/ethnic groups examined.
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影响因子：
120.7
作者：
Cheng, Yiling J.;Kanaya, Alka M.;Imperatore, Giuseppina
通讯作者：
Imperatore, Giuseppina
DOI：
10.1161/hypertensionaha.118.11609
发表时间：
2018-09
期刊：
Hypertension (Dallas, Tex. : 1979)
影响因子：
--
作者：
Lamprea-Montealegre JA;Zelnick LR;Hall YN;Bansal N;de Boer IH
通讯作者：
de Boer IH
影响因子：
3.7
作者：
Eskridge W;Vierling JM;Gosbee W;Wan GA;Hyunh ML;Chang HE
通讯作者：
Chang HE
影响因子：
4.2
作者：
Cuevas, Adolfo G.;O'Brien, Kerth;Saha, Somnath
通讯作者：
Saha, Somnath
影响因子：
25.7
作者：
Asrani, Sumeet K.;Devarbhavi, Harshad;Kamath, Patrick S.
通讯作者：
Kamath, Patrick S.