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Is NASH underdiagnosed among African Americans?
Stephen H Caldwell1, Danielle M Harris, James T Patrie
1Department of Internal Medicine, University of Virginia, Charlottesville 22908-0708, USA.
The American Journal of Gastroenterology
|July 4, 2002
Summary
Despite higher prevalence of risk factors like obesity and type 2 diabetes, African Americans are underrepresented in nonalcoholic steatohepatitis (NASH) and cryptogenic cirrhosis cases, suggesting potential underdiagnosis or referral issues.
Area of Science:
- Hepatology
- Epidemiology
- Internal Medicine
Background:
- Obesity and type 2 diabetes mellitus are significant risk factors for nonalcoholic steatohepatitis (NASH) and cryptogenic cirrhosis.
- These risk factors are notably prevalent in African American females aged 50-60, suggesting a potential for increased NASH and cirrhosis incidence in this demographic.
Purpose of the Study:
- To investigate the ethnic distribution of patients diagnosed with NASH and cryptogenic cirrhosis.
- To compare the prevalence of African Americans with these liver conditions against their representation in the general population and among those with risk factors.
Main Methods:
- Retrospective analysis of a liver disease registry to determine the ethnic breakdown of patients.
- Comparison of ethnic demographics of NASH and cryptogenic cirrhosis patients with the overall registry, local census data, and patients with type 2 diabetes or obesity.
Main Results:
- African Americans were overrepresented among patients with type 2 diabetes and obesity, aligning with risk factor prevalence.
- Conversely, African Americans were significantly underrepresented among patients with NASH (0.6%) and cryptogenic cirrhosis (1%) compared to European Americans.
- Ethnic distribution in the overall registry and for hepatitis C patients mirrored local demographics.
Conclusions:
- A discrepancy exists between the high prevalence of NASH/cryptogenic cirrhosis risk factors in African Americans and their low representation in diagnosed cases.
- Potential explanations include underrecognition, underreferral, or a genuinely lower incidence of these liver diseases in the African American population.