title: Rising incidence and prevalence of primary biliary cirrhosis: a large population-based study.
abstract: OBJECTIVE
  Large population-based studies are much needed to accurately establish the epidemiology of primary biliary cirrhosis (PBC). We aimed to collect all PBC patients in a geographically defined area to evaluate the epidemiology of PBC and examine the possible association of PBC with smoking, age at menarche, age at first pregnancy and number of pregnancies.
  
  
  METHODS
  All PBC patients between 2000 and 2008 were identified in a geographically defined area of the Netherlands, comprising 50% of the Dutch population. Four independent hospital databases were searched in 44 hospitals. Medical records were reviewed on site verifying diagnosis and for collection of clinical data. Age- and gender matched controls were recruited from the outpatient clinics of four participating hospitals. Patients and controls were asked to fill out a questionnaire regarding family history, previous and current smoking behaviour and fertility status.
  
  
  RESULTS
  Nine hundred and ninety-two PBC patients fulfilled all inclusion criteria, resulting in a mean incidence of 1.1 per 100 000; 0.3 in men and 1.9 in women. On January 1st 2008 the point prevalence was 13.2 per 100 000 inhabitants. Incidence and prevalence rates were increasing over time (P < 0.001). No geographical differences in disease distribution were observed. Smoking behaviour, age at menarche, age at first pregnancy, gravidity and number of children were not significantly different between cases and controls.
  
  
  CONCLUSIONS
  Incidence and prevalence rates of PBC are increasing over time. PBC was not found to be associated with smoking, age at menarche, age at first pregnancy or number of pregnancies.
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Boonstra
authors.forename: Anton E
authors.initials: AE
authors.lastname: Kunst
authors.forename: Paul H
authors.initials: PH
authors.lastname: Stadhouders
authors.forename: Hans A
authors.initials: HA
authors.lastname: Tuynman
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Poen
authors.forename: Karin M J
authors.initials: KM
authors.lastname: van Nieuwkerk
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Witteman
authors.forename: Dörte
authors.initials: D
authors.lastname: Hamann
authors.forename: Ben J
authors.initials: BJ
authors.lastname: Witteman
authors.forename: Ulrich
authors.initials: U
authors.lastname: Beuers
authors.forename: Cyriel Y
authors.initials: CY
authors.lastname: Ponsioen
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008105:Liver Cirrhosis, Biliary / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011247:Pregnancy; D015995:Prevalence; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: PBC; epidemiology; population-based; risk factors