No rise in incidence but geographical heterogeneity in the occurrence of primary biliary cirrhosis in North East England

Am J Epidemiol. 2014 Feb 15;179(4):492-8. doi: 10.1093/aje/kwt308. Epub 2014 Jan 8.


In this study, we examined temporal changes in the incidence of primary biliary cirrhosis (PBC) and investigated associations between PBC incidence and sociodemographic factors and spatial clustering. We included 982 patients aged ≥40 years from North East England with incident PBC diagnosed during 1987-2003. Age-standardized incidence rates with 95% confidence intervals were calculated. Negative binomial regression was used to analyze incidence and socioeconomic deprivation. Clustering analysis was performed using point process methods, testing the null hypothesis that disease risk does not vary spatially and that PBC cases occur independently. The age-standardized incidence rate was 53.50 per million persons per year (95% confidence interval: 48.65, 58.35) in 1987-1994 and 45.09 per million persons per year (95% confidence interval: 41.10, 49.07) in 1995-2003. Risk of PBC increased in areas with higher levels of socioeconomic deprivation (P = 0.035). More specifically, risk increased in areas with higher levels of overcrowded homes (P = 0.040), higher levels of households without cars (P < 0.001), and higher levels of non-owner-occupied homes (P < 0.001). Overall, there was evidence of spatial clustering (P = 0.001). The findings confirm that overall incidence of PBC did not rise over time, but sociodemographic variations suggest that certain aspects of deprivation are involved in its etiology.

Keywords: England; environment; etiology; geographic factors; incidence; primary biliary cirrhosis; spatial clustering.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cluster Analysis
  • England / epidemiology
  • Female
  • Geography, Medical
  • Humans
  • Incidence
  • Liver Cirrhosis, Biliary / epidemiology*
  • Male
  • Poverty
  • Risk Factors
  • Socioeconomic Factors