National incidence of autoimmune liver diseases and its relationship with the human development index.
OBJECTIVE
Primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), autoimmune hepatitis (AIH) and immunoglobulin G4 related cholangitis represent the major autoimmune liver diseases (AILD). However, the relationship between AILD incidence and socioeconomic development levels is yet to be explored.


RESULTS
A total of 43 studies were included. There was a positive but not significant correlation between the PBC incidence and HDI on a global level (r=0.348, P=0.082). However, in Europe, a significantly positive correlation existed between the PBC incidence and HDI (r=0.455, P=0.044). No statistical correlation between PSC incidence and HDI was observed (r=0.116, P=0.706). The incidence of AIH revealed a positive correlation with the national HDI both globally (r=0.638, P=0.014) and in Europe (r=0.644, P=0.045). Moreover, the PBC incidence demonstrated a positive correlation with the health index (r=0.422, P=0.036), but a negative correlation with the education index (r= -0.650, P<0.01). Moreover, the income index presented a positive correlation with both the PSC incidence (r=0.599, P=0.031) and the AIH incidence (r=0.649, P=0.012).


METHODS
PubMed was searched to identify relevant epidemiological studies on AILD. The human development index (HDI) was applied as an indicator for socioeconomic development. HDI data were obtained and calculated based on the 2014 Human Development Report. Pearson coefficient and linear regression analysis were conducted to estimate the correlation between incidence and HDI.


CONCLUSIONS
There is positive association between the national incidence of AILD and the socioeconomic status, as measured by HDI. In less-developed countries, the incidence of AILD, especially PBC and AIH, might be less common.
Department of Infection Diseases, Zhejiang Provincial People's Hospital, Hangzhou, China.
Hong-Ying
HY
Pan
Department of Infection Diseases, Zhejiang Provincial People's Hospital, Hangzhou, China.
Yi-Ning
YN
Dai
Department of Hepatology, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.|School of The First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China.
Ji-Na
JN
Zheng
Department of Hepatology, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.|Institute of Hepatology, Wenzhou Medical University, Wenzhou, China.
Ke-Qing
KQ
Shi
Department of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium.
Sven
S
Van Poucke
Department of Infection Diseases, Zhejiang Provincial People's Hospital, Hangzhou, China.
Hai
H
Zou
Department of Hepatology, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.|Institute of Hepatology, Wenzhou Medical University, Wenzhou, China.
Ming-Hua
MH
Zheng
D001327:Autoimmune Diseases / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008107:Liver Diseases / Q000453:epidemiology*; D012959:Socioeconomic Factors
autoimmune hepatitis; autoimmune liver diseases; human development index; primary biliary cirrhosis; primary sclerosing cholangitis