{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T08:01:29Z","timestamp":1769760089881,"version":"3.49.0"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2022,3,15]],"date-time":"2022-03-15T00:00:00Z","timestamp":1647302400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2022,3,15]],"date-time":"2022-03-15T00:00:00Z","timestamp":1647302400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background and Aims<\/jats:title>\n            <jats:p>We investigated associations between ethnicity, survival, and disease severity in a diverse Canadian cohort of patients with primary biliary cholangitis (PBC).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Approach and Results<\/jats:title>\n            <jats:p>Patients with PBC were included from the Canadian Network for Autoimmune Liver Disease. Ethnicity was defined using a modified list adopted from Statistics Canada, and ethnicities with small samples were grouped. Clinical events were defined as liver decompensation, HCC, liver transplantation, or death. Clinical event\u2013free and liver transplantation\u2013free survival were analyzed using Cox regression. Trajectories of serum liver function tests were assessed over time using mixed\u2010effects regression. Health\u2010related quality of life was assessed using the Short Form 36, the PBC\u201040 questionnaire, and the 5\u2010D Itch scale and analyzed using mixed\u2010effects regression. The cohort included 1538 patients with PBC from six sites and was comprised of 82% White, 4.7% Indigenous, 5.5% East Asian, 2.6% South Asian, and 5.1% miscellaneous ethnicities. Indigenous patients were the only ethnic group with impaired liver transplant\u2013free and event\u2010free survival compared to White patients (HR, 3.66; 95% CI, 2.23\u20136.01; HR, 3.09; 95% CI, 1.94\u20134.92). Indigenous patients were more likely to have a clinical event before diagnosis (10%) than all other ethnic groups despite similar age at diagnosis. Indigenous patients presented with higher alkaline phosphatase, total bilirubin, and GLOBE scores than White patients; and these relative elevations persisted during follow\u2010up.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Indigenous Canadians with PBC present with advanced disease and have worse long\u2010term outcomes compared to White patients.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1002\/hep.32426","type":"journal-article","created":{"date-parts":[[2022,2,27]],"date-time":"2022-02-27T00:57:56Z","timestamp":1645923476000},"page":"303-316","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":17,"title":["Ethnicity, disease severity, and survival in Canadian patients with primary biliary cholangitis"],"prefix":"10.1097","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8792-2240","authenticated-orcid":false,"given":"Surain B.","family":"Roberts","sequence":"first","affiliation":[{"name":"Toronto Centre for Liver Disease,Toronto General Hospital,University Health Network,Toronto,Ontario,Canada"},{"name":"Institute of Health Policy, Management and Evaluation,University of Toronto,Toronto,Ontario,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gideon M.","family":"Hirschfield","sequence":"additional","affiliation":[{"name":"Toronto Centre for Liver Disease,Toronto General Hospital,University Health Network,Toronto,Ontario,Canada"},{"name":"Institute of Health Policy, Management and Evaluation,University of Toronto,Toronto,Ontario,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lawrence J.","family":"Worobetz","sequence":"additional","affiliation":[{"name":"Department of Medicine,University of Saskatchewan,Saskatoon,Saskatchewan,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine","family":"Vincent","sequence":"additional","affiliation":[{"name":"D\u00e9partement de M\u00e9decine,Universit\u00e9 de Montr\u00e9al,Montr\u00e9al,Quebec,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9911-0925","authenticated-orcid":false,"given":"Jennifer A.","family":"Flemming","sequence":"additional","affiliation":[{"name":"Department of Medicine,Queen\u2019s University,Kingston,Ontario,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela","family":"Cheung","sequence":"additional","affiliation":[{"name":"Department of Medicine,University of Ottawa,Ottawa,Ontario,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karim","family":"Qumosani","sequence":"additional","affiliation":[{"name":"Department of Medicine,Western University,London,Ontario,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Swain","sequence":"additional","affiliation":[{"name":"Department of Medicine,University of Calgary,Calgary,Alberta,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dusanka","family":"Grbic","sequence":"additional","affiliation":[{"name":"Department de M\u00e9decine,Universit\u00e9 de Sherbrooke,Sherbrooke,Quebec,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6433-5956","authenticated-orcid":false,"given":"Hin Hin","family":"Ko","sequence":"additional","affiliation":[{"name":"Department of Medicine,University of British Columbia,Vancouver,British Columbia,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevork","family":"Peltekian","sequence":"additional","affiliation":[{"name":"Department of Medicine,Dalhousie University,Halifax,Nova Scotia,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9435-2597","authenticated-orcid":false,"given":"Nazia","family":"Selzner","sequence":"additional","affiliation":[{"name":"Toronto General Hospital Research Institute,University Health Network,Toronto,Ontario,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lusine","family":"Abrahamyan","sequence":"additional","affiliation":[{"name":"Institute of Health Policy, Management and Evaluation,University of Toronto,Toronto,Ontario,Canada"},{"name":"Toronto General Hospital Research Institute,University Health Network,Toronto,Ontario,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bishoi","family":"Aziz","sequence":"additional","affiliation":[{"name":"Department of Medicine & Dentistry,University of Alberta,Edmonton,Alberta,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ellina","family":"Lytvyak","sequence":"additional","affiliation":[{"name":"Department of Medicine & Dentistry,University of Alberta,Edmonton,Alberta,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kattleya","family":"Tirona","sequence":"additional","affiliation":[{"name":"Toronto Centre for Liver Disease,Toronto General Hospital,University Health Network,Toronto,Ontario,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aliya F.","family":"Gulamhusein","sequence":"additional","affiliation":[{"name":"Toronto Centre for Liver Disease,Toronto General Hospital,University Health Network,Toronto,Ontario,Canada"},{"name":"Institute of Health Policy, Management and Evaluation,University of Toronto,Toronto,Ontario,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harry L. A.","family":"Janssen","sequence":"additional","affiliation":[{"name":"Toronto Centre for Liver Disease,Toronto General Hospital,University Health Network,Toronto,Ontario,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aldo J.","family":"Montano\u2010Loza","sequence":"additional","affiliation":[{"name":"Department of Medicine & Dentistry,University of Alberta,Edmonton,Alberta,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew L.","family":"Mason","sequence":"additional","affiliation":[{"name":"Department of Medicine & Dentistry,University of Alberta,Edmonton,Alberta,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bettina E.","family":"Hansen","sequence":"additional","affiliation":[{"name":"Toronto Centre for Liver Disease,Toronto General Hospital,University Health Network,Toronto,Ontario,Canada"},{"name":"Institute of Health Policy, Management and Evaluation,University of 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