title: Are there ethnicity-based differences in the evaluation of individuals with abnormal liver biochemistries?
abstract: OBJECTIVE
  Recent studies suggested NAFLD is less infrequent in African Americans (AA) than in Caucasians but it is unclear if this difference is biological or due to under-recognition/under-referral. This study examined if there is an ethnicity-based difference in obtaining liver biochemistries or evaluating abnormal liver biochemistries by primary care physicians.
  
  
  METHODS
  This study consisted of 45,016 AA and 49,660 Caucasians seen at our primary care clinics over a 3-year period. From these two groups, we identified patients with elevated aminotransferases (AA: 3676, Caucasians: 4644) and elevated bilirubin (AA: 1295, Caucasians: 1199) based on predefined criteria. Subsequently, we assessed the proportion of patients in each group who had liver-specific evaluation (viral serologies, abdominal imaging or GI clinic visit).
  
  
  RESULTS
  Among patients with elevated aminotransferases, compared to Caucasians, AA did not have lower testing for viral hepatitis (26% vs. 25%), imaging (16% vs. 13%) or GI clinic visits (17% vs. 17%). Similarly, we did not observe clinically significant difference in the evaluation of elevated bilirubin between AA and Caucasians (viral serologies: 22% vs. 22%; imaging: 25% vs. 27%; GI clinic: 15% vs. 21%).
  
  
  CONCLUSIONS
  Under-recognition and under-referral are not likely to explain the reported ethnic differences in the prevalence of NAFLD.
authors.affiliation: Department of Medicine, Indiana University School of Medicine, USA. nchalasa@iupui.edu
authors.forename: Naga
authors.initials: N
authors.lastname: Chalasani
authors.forename: Chandan
authors.initials: C
authors.lastname: Saha
authors.forename: Evgenia
authors.initials: E
authors.lastname: Teal
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D044383:Black People; D005234:Fatty Liver / Q000453:epidemiology* / Q000208:ethnology* / Q000378:metabolism; D005260:Female; D006801:Humans; D008099:Liver / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D000637:Transaminases / Q000097:blood; D014481:United States / Q000208:ethnology; D044465:White People; D001741:Black or African American
chemical_list: D000637:Transaminases; D000410:Alanine Transaminase; C022636:serine-glyoxylate aminotransferase