title: Primary biliary cirrhosis in Southern Israel: a 20 year follow up study.
abstract: BACKGROUND
  The epidemiology of primary biliary cirrhosis (PBC) in Israel is unknown. We aimed to determine the epidemiology, long-term survival and outcomes of PBC in Southern Israel from 1990 to 2010.
  
  
  METHODS
  Case-finding methods and population-based administrative data were used to estimate and evaluate the incidence, prevalence and prognostic factors of outcome in our PBC cohort.
  
  
  RESULTS
  138 cases of PBC were identified. The average annual prevalence of PBC was 255 cases per million. The overall age/sex-adjusted annual incidence of PBC was 10 cases per million from 1990 through 1999 and 20 cases per million from 2000 to 2010. Among 138 incident cases with a total follow-up of 960 persons-years from diagnosis, 30 patients (21.7%) died. Survival in PBC patients was significantly lower than that of the age/sex-matched Israeli population. Mortality was significantly increased in patients with an initial MELD score greater than 8 (P<0.001), with portal hypertension (P<0.001), and in non-responders to ursodeoxycholic acid (UDCA) therapy according to Barcelona criteria (P=0.005). Out of 138 patients, 95 patients (68.0%) responded to UDCA therapy according to Barcelona and Paris criteria. None of the responders died during the follow-up period as opposed to 30 out of 43 (69.8%) of non-responders. In multivariate analysis the factors associated with response to UDCA were: albumin levels above 3.5 g/dL (P<0.001) and lower degree of fibrosis per liver biopsy (P=0.003).
  
  
  CONCLUSIONS
  This study addresses the increasing burden of PBC in Israel and confirms the importance of some clinical and therapeutic factors as predictors of long-term prognosis.
authors.affiliation: Department of Gastroenterology and Hepatology, The Barzilai Medical Center, Faculty of Health Sciences, Ben-Gurion University of The Negev, Israel. delgado@bgu.ac.il
authors.forename: Jorge-Shmuel
authors.initials: JS
authors.lastname: Delgado
authors.forename: Alina
authors.initials: A
authors.lastname: Vodonos
authors.forename: Bertha
authors.initials: B
authors.lastname: Delgado
authors.forename: Alan
authors.initials: A
authors.lastname: Jotkowitz
authors.forename: Alexander
authors.initials: A
authors.lastname: Rosenthal
authors.forename: Alexander
authors.initials: A
authors.lastname: Fich
authors.forename: Victor
authors.initials: V
authors.lastname: Novack
mesh_terms: D000328:Adult; D018912:Arabs / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D007585:Jews / Q000706:statistics & numerical data*; D008105:Liver Cirrhosis, Biliary / Q000208:ethnology* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D017741:Survivors / Q000706:statistics & numerical data*; D013997:Time Factors