{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T23:49:15Z","timestamp":1790293755796,"version":"4.1.0"},"reference-count":40,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2021,5,28]],"date-time":"2021-05-28T00:00:00Z","timestamp":1622160000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["K23DK11456"],"award-info":[{"award-number":["K23DK11456"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Failure of immunologic homeostasis and resultant hepatocyte destruction in autoimmune hepatitis (AIH) is likely the result of environmental triggers within a permissive genetic architecture.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>We aimed to identify risk factors associated with AIH in a well\u2010phenotyped AIH cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We prospectively collected environmental questionnaires from 358 AIH cases and 563 healthy controls. Response frequencies were compared using logistic regression, adjusting for age at recruitment, sex and education.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>AIH cases were more likely to ever have a urinary tract infection (UTI) (53.6% vs 33.9%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001) and recurrent UTI (more than 1 per year) (23.5% vs 15.9%, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.002) compared to controls. Female cases more frequently had ever used oral contraceptives (83.0% vs 73.7%, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.006), fewer pregnancies (median\u00a0=\u00a01 vs 3, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001) and less often used hormone replacement therapy compared to controls (28.5% vs 60.1%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001). Current smoking was more prevalent in cases (18.9% vs 7.4%, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.022), yet no difference according to historical smoking behaviours was observed. Finally, cases were less likely to have history of mumps (32.4% vs 53.1%, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.011) and rheumatic fever (1.1% vs 4.4%, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.028), but reported higher vaccination frequency to chicken pox (38% vs 28.1%), measles (66.5% vs 39.3%), mumps (58.7% vs 34.6%), rubella (55.3% vs 32.7%), pertussis (59.8% vs 40.1%) and pneumococcus (47.2% VS 39.4%) (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.002).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Environmental factors are important in AIH pathogenesis. Replication of these findings and prospective examination may provide\u00a0new insight into\u00a0AIH onset and outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.14944","type":"journal-article","created":{"date-parts":[[2021,5,12]],"date-time":"2021-05-12T10:44:40Z","timestamp":1620816280000},"page":"2396-2403","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Environmental risk factors are associated with autoimmune hepatitis"],"prefix":"10.1111","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3809-640X","authenticated-orcid":false,"given":"Craig","family":"Lammert","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology Indiana University School of Medicine Indianapolis IN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sai N.","family":"Chalasani","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology 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