S1291 Prevalence of Hepatitis and Its Etiologic Changes Over Time in African Americans in a University Teaching Hospital

Abstract

BACKGRAUND: African Americans (AAs) and Hispanic Americans have a greater risk of developing liver disease than white. In this study we analyzed the prevalence of hepatitis, stage of fibrosis, and cirrhosis from liver biopsy findings of AAs with hepatitis and determined if there are etiologic, or demographic changes over a period of five decades. METHODS: Liver biopsy data, were collected from pathology and medical records at Howard University Hospital from 1959 to 2008. Analysis of the data was done for demographic characteristics, chronicity, stage of fibrosis, and possible etiologies. Continuous variables were described with mean values (SD), and frequency table was used for categorical variables. Student's ttest and Chi-square were applied to test the difference of continuous and categorical variables among study groups, respectively. RESULTS: A total of 781 cases of hepatitis were available for analysis. The age range was 15-84 yrs old with mean (SD) of 45.7 (14.6). Males were 428 (55%), and females were 355 (45%). About 50% of the cases were in the middle age group (40-60 years old). Out of the total hepatitis cases, 746 (95%) were chronic liver disease (CLD), of which 107 (14 %) were cirrhosis. About 477 (64%) of the CLD had identifiable etiologic causes. These were viral 287 (60%), inflammatory 42 (9%), fatty changes 20 (4%), alcohol 17 (4%), metabolic 13 (3%) and cholestatic 9 (2%).. Of total CLD (639 cases), excluding cirrhosis, 182 (29%) had fibrosis at different stages. One hundred forty (77%), were in stages 1-2 and 42 (23%) were in stages 3-4. There was no difference between viral and non viral etiology as a cause of fibrosis (P=0.7), or mean age of distribution for the fibrosis (P=0.4). HCV has 156/639 (42%) fibrosis rate. In addition, a significant increase in the total prevalence of chronic hepatitis 295(46.2%) in the years from 2000-2008 was observed compared to the previous decades (P<0.001). There was no difference with regard to sex (P=0.4) or viral etiology (P=0.1) in the prevalence rate of CLD in the last five decades when we compare one decade to the other. The prevalence of cirrhosis in our data was 14 %, with a mean age of 46.6 (SD=14.6). The mean age of the total hepatitis cases was significantly older, 50.8 (SD 9.0) in the year 2000-2008 data (P=<0.001) compared to the prior four decades. CONCLUSION: Our data showed CLD is more in males and is increased significantly (p<0.001) in recent eight years. Further investigation is needed to determine whether this increase is due to improved and better diagnostic techniques, vs. a real increase in incidence of chronic liver disease and cirrhosis.