Environmental Exposures Are Important Risk Factors for Advanced Liver Fibrosis in African American Adults

Details

• Personal Author:
  Aloman C ; Bansal MB ; Branch AD ; Crane M ; Dieterich D ; Dinani A ; Henschke C ; Jirapatnakul A ; Lewis S ; Li L ; Ma N ; Wyatt B ; Wyatt C ; Yankelevitz D ; Yip R
• Description:
  Background & Aims: 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. Methods: 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. Results: 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. Conclusions: 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. Impact and Implications: 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. [Description provided by NIOSH]
• Subjects:
  Alcoholic Beverages Environmental Exposure Environmental Pollution Fibrosis Healthcare Disparities Occupational Health Race Factors Safety Smokers Tobacco Products
• Keywords:
  Alcoholic Beverages Author Keywords: Environmental Toxins Cigarette Smoking Environmental Exposure Environmental Pollution Etiology Health Disparities Liver Disease Non-invasive Scores Racial Disparities Racial Factors Screening

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• ISSN:
  2589-5559
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Journal Article
• Place as Subject:
  Illinois ; New York ; North Carolina ; OSHA Region 2 ; OSHA Region 4 ; OSHA Region 5
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  5
• Issue:
  4
• NIOSHTIC Number:
  nn:20066548
• Citation:
  JHEP Rep 2023 Apr; 5(4):100696
• Contact Point Address:
  Andrea D. Branch, Professor of Medicine, Division of Liver Diseases, Director of Basic and Translational Research Institute of Liver Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1123, New York, NY 10029
• Email:
  andrea.branch@mssm.edu
• Federal Fiscal Year:
  2023
• Performing Organization:
  Icahn School of Medicine at Mount Sinai, New York
• Peer Reviewed:
  True
• Start Date:
  20210701
• Source Full Name:
  JHEP Reports
• End Date:
  20240630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:53b3bc3b22b1bb3df922083f0175f5026d061b55f2dcfc036ecd1571e85cef4fdd9acd7fac5cc3ec93bb2427cf7f713236fcb304c50a5109cd5dda65b01a3336
• Download URL:
  https://stacks.cdc.gov/view/cdc/231118/cdc_231118_DS1.pdf
• File Type:
  [PDF - 1.42 MB ]