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Roberts SB, Hirschfield GM, Worobetz LJ, Vincent C, Flemming JA, Cheung A, Qumosani K, Swain M, Grbic D, Ko HH, Peltekian K, Selzner N, Abrahamyan L, Aziz B, Lytvyak E, Tirona K, Gulamhusein AF, Janssen HLA, Montano-Loza AJ, Mason AL, Hansen BE. Ethnicity, disease severity, and survival in Canadian patients with primary biliary cholangitis. Hepatology 2022; 76:303-316. [PMID: 35220609 DOI: 10.1002/hep.32426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/21/2022] [Accepted: 02/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS We investigated associations between ethnicity, survival, and disease severity in a diverse Canadian cohort of patients with primary biliary cholangitis (PBC). APPROACH AND RESULTS Patients with PBC were included from the Canadian Network for Autoimmune Liver Disease. Ethnicity was defined using a modified list adopted from Statistics Canada, and ethnicities with small samples were grouped. Clinical events were defined as liver decompensation, HCC, liver transplantation, or death. Clinical event-free and liver transplantation-free survival were analyzed using Cox regression. Trajectories of serum liver function tests were assessed over time using mixed-effects regression. Health-related quality of life was assessed using the Short Form 36, the PBC-40 questionnaire, and the 5-D Itch scale and analyzed using mixed-effects regression. The cohort included 1538 patients with PBC from six sites and was comprised of 82% White, 4.7% Indigenous, 5.5% East Asian, 2.6% South Asian, and 5.1% miscellaneous ethnicities. Indigenous patients were the only ethnic group with impaired liver transplant-free and event-free survival compared to White patients (HR, 3.66; 95% CI, 2.23-6.01; HR, 3.09; 95% CI, 1.94-4.92). Indigenous patients were more likely to have a clinical event before diagnosis (10%) than all other ethnic groups despite similar age at diagnosis. Indigenous patients presented with higher alkaline phosphatase, total bilirubin, and GLOBE scores than White patients; and these relative elevations persisted during follow-up. CONCLUSIONS Indigenous Canadians with PBC present with advanced disease and have worse long-term outcomes compared to White patients.
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Affiliation(s)
- Surain B Roberts
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Gideon M Hirschfield
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lawrence J Worobetz
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Catherine Vincent
- Département de Médecine, Université de Montréal, Montréal, Quebec, Canada
| | | | - Angela Cheung
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Karim Qumosani
- Department of Medicine, Western University, London, Ontario, Canada
| | - Mark Swain
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dusanka Grbic
- Department de Médecine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Hin Hin Ko
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevork Peltekian
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Nazia Selzner
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Lusine Abrahamyan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Bishoi Aziz
- Department of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ellina Lytvyak
- Department of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Kattleya Tirona
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Aliya F Gulamhusein
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Harry L A Janssen
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Aldo J Montano-Loza
- Department of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Andrew L Mason
- Department of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Bettina E Hansen
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Chahal D, Marquez V, Hussaini T, Kim P, Chung SW, Segedi M, Chartier-Plante S, Scudamore CH, Erb SR, Salh B, Yoshida EM. End stage liver disease etiology & transplantation referral outcomes of major ethnic groups in British Columbia, Canada: A cohort study. Medicine (Baltimore) 2021; 100:e27436. [PMID: 34678872 PMCID: PMC8542110 DOI: 10.1097/md.0000000000027436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 09/17/2021] [Indexed: 01/15/2023] Open
Abstract
Liver disease etiology and transplantation outcomes may vary by ethnicity. We aimed to determine if disparities exist in our province.We reviewed the provincial database for liver transplant referrals. We stratified cohorts by ethnicity and analyzed disease etiology and outcomes.Four thousand nine hundred sixteen referrals included 220 South Asians, 413 Asians, 235 First Nations (Indigenous), and 2725 Caucasians. Predominant etiologies by ethnicity included alcohol (27.4%) and primary sclerosing cholangitis (PSC) (8.8%) in South Asians, hepatitis B (45.5%) and malignancy (13.9%) in Asians, primary biliary cholangitis (PBC) (33.2%) and autoimmune hepatitis (AIH) (10.8%) in First Nations, and hepatitis C (35.9%) in Caucasians. First Nations had lowest rate of transplantation (30.6%, P = .01) and highest rate of waitlist death (10.6%, P = .03). Median time from referral to transplantation (268 days) did not differ between ethnicities (P = .47). Likelihood of transplantation increased with lower body mass index (BMI) (hazard ratio [HR] 0.99, P = .03), higher model for end stage liver disease (MELD) (HR 1.02, P < .01), or fulminant liver failure (HR 9.47, P < .01). Median time from referral to ineligibility status was 170 days, and shorter time was associated with increased MELD (HR 1.01, P < .01), increased age (HR 1.01, P < .01), fulminant liver failure (HR 2.56, P < .01) or South Asian ethnicity (HR 2.54, P < .01). Competing risks analysis revealed no differences in time to transplant (P = .66) or time to ineligibility (P = .91) but confirmed increased waitlist death for First Nations (P = .04).We have noted emerging trends such as alcohol related liver disease and PSC in South Asians. First Nations have increased autoimmune liver disease, lower transplantation rates and higher waitlist deaths. These data have significance for designing ethnicity specific interventions.
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Affiliation(s)
- Daljeet Chahal
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vladimir Marquez
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Trana Hussaini
- Faculty of Pharmaceutical Sciences, University of British Columbia, British Columbia, Canada
| | - Peter Kim
- Department of Surgery, Section of Hepatobiliary Pancreatic Surgery, University of British Columbia and the Liver Transplant Program, Vancouver General Hospital, British Columbia, Canada
| | - Stephen W. Chung
- Department of Surgery, Section of Hepatobiliary Pancreatic Surgery, University of British Columbia and the Liver Transplant Program, Vancouver General Hospital, British Columbia, Canada
| | - Maja Segedi
- Department of Surgery, Section of Hepatobiliary Pancreatic Surgery, University of British Columbia and the Liver Transplant Program, Vancouver General Hospital, British Columbia, Canada
| | - Stephanie Chartier-Plante
- Department of Surgery, Section of Hepatobiliary Pancreatic Surgery, University of British Columbia and the Liver Transplant Program, Vancouver General Hospital, British Columbia, Canada
| | - Charles H. Scudamore
- Department of Surgery, Section of Hepatobiliary Pancreatic Surgery, University of British Columbia and the Liver Transplant Program, Vancouver General Hospital, British Columbia, Canada
| | - Siegfried R. Erb
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Baljinder Salh
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric M. Yoshida
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
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Asuri S, McIntosh S, Taylor V, Rokeby A, Kelly J, Shumansky K, Field LL, Yoshida EM, Arbour L. Primary Biliary Cholangitis in British Columbia First Nations: Clinical features and discovery of novel genetic susceptibility loci. Liver Int 2018; 38:940-948. [PMID: 29297981 DOI: 10.1111/liv.13686] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 12/21/2017] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Primary Biliary Cholangitis (PBC) is a chronic autoimmune liver disease characterized by destruction of intrahepatic bile ducts, portal inflammation and cirrhosis. Although rare in most populations, it is prevalent and often familial in British Columbia First Nations. We hypothesized that major genetic factors increased the risk in First Nations. METHODS In all, 44 individuals with Primary Biliary Cholangitis and 61 unaffected relatives from 32 First Nations families participated. Family history and co-morbidities were documented. Medical records were reviewed and available biopsies were re-reviewed by our team pathologist. Genotyping was performed on DNA from 36 affected persons and 27 unaffected relatives using the Affymetrix Human Mapping 500K Array Set. MERLIN software was used to carry out multipoint parametric and nonparametric linkage analysis. Candidate genes were identified and entered into InnateDB and KEGG software to identify potential pathways affecting pathogenesis. RESULTS In all, 34% of families were multiplex. Fifty per cent of cases and 33% of unaffected relatives reported other autoimmune disease. Three genomic regions (9q21, 17p13 and 19p13) produced LOD scores of 2.3 or greater suggestive of linkage, but no single linkage peak reached statistical significance. Candidate genes identified in the three regions suggested involvement of IL17, NFκB, IL6, JAK-STAT, IFNγ and TGFβ immune signalling pathways. Specifically, four genes-ACT1, PIN1, DNMT1 and NTN1-emerged as having roles in these pathways that may influence Primary Biliary Cholangitis pathogenesis. CONCLUSIONS Our whole genome linkage study results reflect the multifactorial nature of Primary Biliary Cholangitis, support previous studies suggesting signalling pathway involvement and identify new candidate genes for consideration.
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Affiliation(s)
- Sirisha Asuri
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Sarah McIntosh
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Valerie Taylor
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - Andrew Rokeby
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - James Kelly
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Karey Shumansky
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Lanora Leigh Field
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Eric M Yoshida
- Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - Laura Arbour
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada.,Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
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Utiyama SRDR, Ribas JLC, Nisihara RM, Kotze LMDS, de Messias-Reason IJ. Celiac disease in native Indians from Brazil: A clinical and epidemiological survey. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2012; 2:138-42. [PMID: 22624128 PMCID: PMC3354426 DOI: 10.4297/najms.2010.3138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Celiac disease has been described in populations from around the world, with recent data emphasizing the occurrence of the disease in ethnic minorities. There are only a few studies evaluating celiac disease in native Indians. Aims: This study aimed to screen the anti-endomysial antibody (IgA-EmA) in Kaingang and Guarani Indians from southern Brazil, in order to establish a clinical serological evaluation of celiac disease in these individuals. Material and Methods: Serum samples from 321 individuals (125 male and 196 female; 4-86 years old) from Mangueirinha Indigenous Reserve, State of Parana, Brazil, and 180 non-Indigenous healthy individuals (62 male and 118 female; 2-81 years old) were analysed to the presence of anti-endomysial antibody class IgA by indirect immunofluorescence assay. Amongst the Indians, 158 were Kaingang, 98 Guarani and 65 of mixed race. Indians presenting complaints of diarrhea (N=12) were also evaluated to the IgG class of anti-endomisyal antibody. Results: None of the individuals showed positive results either to IgA or IgG anti-endomysial antibodies. Conclusions: Although the results indicate an absence of celiac disease in Kaingang and Guarani Indians, the authors call attention to the importance of following up indigenous children or adults presenting gastrointestinal complaints or other symptoms related to the disease. Consideration should be given to the genetic background of these individuals, allied to the inter ethnic marriages and the changing habits or occupational activities, that have gradually introduced diseases previously not described in indigenous populations.
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Liver transplant outcomes in a Canadian First Nations population. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2011; 25:307-10. [PMID: 21766089 DOI: 10.1155/2011/986945] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND A higher incidence of autoimmune disorders may predispose First Nations (FN) individuals to higher rates and more severe episodes of rejection, graft loss and mortality following liver transplantation for advanced liver disease. METHODS A retrospective review of patient outcomes in a single centre providing long-term follow-up care for FN and non-FN patients transplanted for advanced liver disease was conducted. RESULTS A total of 20 FN and 129 non-FN charts were available for review. FN subjects were younger at transplantation (mean [± SD] age 32.4±4.1 years versus 46.3±1.4 years; P=0.00005), less often male (35% versus 58%; P=0.05), more commonly transplanted for autoimmune hepatitis (30% versus 4.7%; P=0.006), less often from urban residences (25% versus 74%; P=0.0001) and less compliant with medical care (20% versus 80%; P=0.007). After a mean follow-up period of 11.0±1.5 years and 8.4±0.5 years in FN and non-FN subjects, respectively, the incidence and severity of rejection, graft and patient survival were similar between cohorts. CONCLUSION Although demographic profiles, nature of the underlying disease and compliance differed, the rates and severity of rejection, graft and patient survival were similar in FN and non-FN patients who underwent liver transplantation for advanced liver disease.
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Lessons learned from liver transplantation with the Canadian First Nations. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2011; 25:305-6. [PMID: 21766088 DOI: 10.1155/2011/276190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Autoimmune hepatitis in a North American Aboriginal/First Nations population. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2009; 22:829-34. [PMID: 18925307 DOI: 10.1155/2008/642432] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
North American Aboriginal populations are at increased risk for developing immune-mediated disorders, including autoimmune hepatitis. In the present study, the demographic, clinical, biochemical, serological, radiological and histological features of autoimmune hepatitis were compared in 33 First Nations (FN) and 150 predominantly Caucasian, non-FN patients referred to an urban tertiary care centre. FN patients were more often female (91% versus 71%; P=0.04), and more likely to have low serum albumin (69% versus 36%; P=0.0006) and elevated bilirubin (57% versus 35%; P=0.01) levels on presentation compared with non-FN patients. They also had lower hemoglobin, and complement levels, more cholestasis and higher serum immunoglobulin A levels than non-FN patients (P=0.05 respectively). Higher histological grades of inflammation and stages of fibrosis, and more clinical and radiological evidence of advanced liver disease were observed in FN patients, but the differences failed to reach statistical significance. The results of the present study suggest that in addition to being more common, autoimmune hepatitis may be more severe in FN populations, compared with predominantly Caucasian, non-FN populations.
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8
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Scott JD, Garland N. Chronic liver disease in Aboriginal North Americans. World J Gastroenterol 2008; 14:4607-15. [PMID: 18698674 PMCID: PMC2738784 DOI: 10.3748/wjg.14.4607] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Revised: 05/28/2008] [Accepted: 06/04/2008] [Indexed: 02/06/2023] Open
Abstract
A structured literature review was performed to detail the frequency and etiology of chronic liver disease (CLD) in Aboriginal North Americans. CLD affects Aboriginal North Americans disproportionately and is now one of the most common causes of death. Alcoholic liver disease is the leading etiology of CLD, but viral hepatitis, particularly hepatitis C, is an important and growing cause of CLD. High rates of autoimmune hepatitis and primary biliary cirrhosis (PBC) are reported in regions of coastal British Columbia and southeastern Alaska. Non-alcoholic liver disease is a common, but understudied, cause of CLD. Future research should monitor the incidence and etiology of CLD and should be geographically inclusive. In addition, more research is needed on the treatment of hepatitis C virus (HCV) infection and non-alcoholic fatty liver disease (NAFLD) in this population.
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Chung HV, Riley M, Ho JK, Leung B, Jevon GP, Arbour LT, Barker C, Schreiber R, Yoshida EM. Retrospective review of pediatric and adult autoimmune hepatitis in two quaternary care centres in British Columbia: increased prevalence seen in British Columbia's First Nations community. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2007; 21:565-8. [PMID: 17853950 PMCID: PMC2657988 DOI: 10.1155/2007/757906] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND It has been previously reported that British Columbia's (BC's) First Nations (Aboriginal) community has an increased risk of autoimmune diseases, including rheumatological conditions (rheumatoid arthritis, systemic lupus) and primary biliary cirrhosis. The researchers hypothesized that this community may also be at increased risk for autoimmune hepatitis (AIH). METHODS Independent, retrospective reviews of the databases of two separate tertiary/quaternary British Columbia university-affiliated health care institutions, the Adult Liver Transplant Program of the BC Transplant Society and the Division of Pediatric Gastroenterology, BC Children's Hospital (Vancouver, BC), were performed. All patients referred with a diagnosis of probable or definite AIH who identified themselves as being of First Nations descent from 1988 to 2004 were reviewed. The liver transplant database records all adult patients in the province referred for transplant assessment. The pediatric database records all children referred to the BC Children's Hospital. RESULTS A total of 68 adult patients with a definite or probable diagnosis of AIH were referred to the liver transplant program. Twelve patients (17.6%) were Aboriginal, 11 of which were female. Similarly, a total of 30 children with probable or definite AIH were identified from the pediatric database. Six of these cases (20%) were identified in Aboriginal children. CONCLUSIONS The findings suggest an increased prevalence of AIH among BC's First Nations community. A disproportionate First Nations representation was found on independent review of two databases. Future studies are needed to determine the true prevalence of AIH in this community, and to uncover the genetic predisposition and the environmental triggers explaining this phenomenon.
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Affiliation(s)
- Henry V Chung
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Mark Riley
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Jin K Ho
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Benjamin Leung
- Department of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Gareth P Jevon
- Department of Pathology, University of British Columbia, Vancouver, British Columbia
| | - Laura T Arbour
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia
| | - Colin Barker
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Richard Schreiber
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Eric M Yoshida
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia
- British Columbia Transplant Society, Vancouver, British Columbia
- Correspondence: Dr Eric M Yoshida, Division of Gastroenterology, Vancouver General Hospital, Diamond Health Care Centre, Suite #5153 – 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9. Telephone 604-875-5371, fax 604-875-5373, e-mail
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Razack S. Promoting skill-building in cultural competence: A must for paediatricians who care for socially vulnerable populations. Paediatr Child Health 2007; 12:657-9. [PMID: 19030442 DOI: 10.1093/pch/12.8.657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2007] [Indexed: 11/13/2022] Open
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Arbour L, Cook D. DNA on loan: issues to consider when carrying out genetic research with aboriginal families and communities. Public Health Genomics 2006; 9:153-60. [PMID: 16741344 DOI: 10.1159/000092651] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In the current research milieu where genetic etiology is considered a critical component in the discovery of pathogenesis, aboriginal families and communities affected with genetic conditions may be considered as research participants. However, because of concerns about the impact of genetic information and historical harmful research practices, some aboriginal communities have considerable unease when faced with this prospect. Therefore, in the circumstance that genetics is considered an important part of research inquiry by aboriginal families and communities, there needs to be assurance that the research will be carried out according to mutual expectations. A research relationship that respects aboriginal individuals and communities within their culture and is in keeping with their values is essential. This respect extends to the use of biological samples, considering the DNA to be 'on loan' to the researcher for the purpose of the research for which consent was obtained. This paper will explore practical ways of maintaining a respectful research relationship when genetics research with aboriginal people is undertaken.
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Affiliation(s)
- Laura Arbour
- University of British Columbia, Vancouver, Canada
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12
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Yoshida EM, Riley M, Arbour LT. Autoimmune liver disease and the Canadian First Nations Aboriginal Communities of British Columbia’s Pacific Northwest. World J Gastroenterol 2006; 12:3625-7. [PMID: 16773676 PMCID: PMC4087452 DOI: 10.3748/wjg.v12.i23.3625] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Primary biliary cirrhosis (PBC) is a well-known but uncommon chronic liver disease that is presumed to be of autoimmune etiology. Recently, investigations in British Columbia (BC), a province of Canada situated along the Pacific North-West of North America, have suggested that PBC is not a rare disease amongst BC’s Aboriginal (i.e. First Nations) communities. Geographically, BC is adjacent to South East Alaska, an American state that has also reported an increased prevalence of PBC amongst its Aboriginal communities. In this article, the medical evidence supporting a hypothesis of increased risk of PBC amongst BC’s First Nations communities is reviewed. Evidence suggesting that autoimmune hepatitis is also more likely amongst BC’s First Nations communities is also presented.
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MESH Headings
- Autoimmune Diseases/epidemiology
- Autoimmune Diseases/ethnology
- Autoimmune Diseases/etiology
- Autoimmune Diseases/genetics
- British Columbia/epidemiology
- British Columbia/ethnology
- Causality
- Cholangitis, Sclerosing/epidemiology
- Cholangitis, Sclerosing/ethnology
- Cholangitis, Sclerosing/etiology
- Cholangitis, Sclerosing/genetics
- Genetic Predisposition to Disease
- Hepatitis, Autoimmune/epidemiology
- Hepatitis, Autoimmune/ethnology
- Hepatitis, Autoimmune/etiology
- Hepatitis, Autoimmune/genetics
- Humans
- Incidence
- Indians, North American/ethnology
- Indians, North American/genetics
- Liver Cirrhosis, Biliary/epidemiology
- Liver Cirrhosis, Biliary/ethnology
- Liver Cirrhosis, Biliary/etiology
- Liver Cirrhosis, Biliary/genetics
- Liver Diseases/epidemiology
- Liver Diseases/ethnology
- Liver Diseases/etiology
- Liver Diseases/genetics
- Risk Factors
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Affiliation(s)
- Eric-M Yoshida
- Department of Medicine, University of British Columbia, Vancouver, Canada.
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Alvord LA, Rhoades D, Henderson WG, Goldberg JH, Hur K, Khuri SF, Buchwald D. Surgical Morbidity and Mortality among American Indian and Alaska Native Veterans: A Comparative Analysis. J Am Coll Surg 2005; 200:837-44. [PMID: 15922193 DOI: 10.1016/j.jamcollsurg.2005.01.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2004] [Revised: 01/19/2005] [Accepted: 01/19/2005] [Indexed: 11/16/2022]
Abstract
BACKGROUND Few studies have examined surgical risk factors and outcomes in American Indians and Alaska Natives (AI/ANs). My colleagues and I sought to determine if prevalence of preoperative risk factors for morbidity and mortality differed between male AI/AN and Caucasian surgical patients, and to determine if AI/ANs had an increased risk of surgical morbidity or mortality. STUDY DESIGN We obtained data from the Veterans Affairs National Surgical Quality Improvement Program on major, noncardiac, surgical procedures performed between 1991 and 2002 for all AI/AN men (n = 2,155) and a random sample of Caucasian men (n = 2,264), matched by facility. Chi-square and t-test analyses were used to assess differences in preoperative risk factors between the two groups. Logistic regression was used to determine whether AI/AN race was independently associated with 30-day morbidity (defined as 1 or more of 21 postoperative complications) or 30-day all cause mortality after adjustment for major risk factors. RESULTS Prevalence of major preoperative risk factors for morbidity and mortality often differed between the groups. Compared with Caucasians, AI/AN race did not predict morbidity (adjusted odds ratio, 0.92; 95% CI, 0.75-1.13), but AI/ANs were at higher risk for 30-day all cause postoperative mortality (adjusted odds ratio, 1.56; 95% CI, 1.04-2.35). CONCLUSIONS Our results add postoperative mortality to health disparities experienced by AI/ANs. Future research should be conducted to identify other factors that contribute to this disparity.
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