Examining Disparities in Primary Biliary Cholangitis: A Clinical Analysis at a Non-Academic Center in the Greater Los Angeles Area

Summary for Medical Professionals

Title: Examining Disparities in Primary Biliary Cholangitis: A Clinical Analysis at a Non-Academic Center in the Greater Los Angeles Area
 Authors: Sabrina Alff, Orlinda E. Ventura, Trinity Love Foster-Malave, Michel Mendler, MD, MS, and Edward Mena, MD, MBA, FAASLD
Institution: California Liver Research Institute (Part of Pasadena Liver Center)

Background:
 Primary Biliary Cholangitis (PBC) is a chronic autoimmune cholestatic liver disease that can progress to cirrhosis and liver failure. Prior studies—largely from academic centers—have documented racial and ethnic differences in PBC presentation and outcomes. However, real-world data from community-based hepatology clinics are limited, particularly among Hispanic/Latino populations, who are often underrepresented in clinical research.

Methods:
 This retrospective study analyzed 184 ethnically self-identified PBC patients (out of 362 total) seen between January 2009 and July 2023 at the Pasadena Liver Center.
PBC diagnosis followed AASLD guidelines, and disease severity was assessed through FibroScan® stiffness, biopsy data, and laboratory markers.
Variables examined included demographics, socioeconomic indicators (Area Deprivation Index – ADI), metabolic and autoimmune comorbidities (including MASLD and autoimmune hepatitis overlap), and fibrosis stage.
Univariate and multivariate analyses (JMP® 17.1.0, SAS)[ can be removed, not pertinent] identified independent predictors of advanced fibrosis (F2–F4).

Key Findings:

  • 50% of patients were Hispanic/Latino (HL); 83% female; median age 62 years.

  • HL patients were significantly more socioeconomically disadvantaged by ADI ranking (p<0.01).

  • HL patients had higher BMI (26.7 vs. 22.4; p=0.0025) and greater prevalence of MASLD (45.6% vs. 19.4%; p=0.0001).

  • Over half of the cohort presented with overlapping liver conditions:

    • PBC alone (“1 hit”): 52.2%

    • PBC + MASLD or AIH (“2 hits”): 40.8%

    • PBC + MASLD + AIH (“3 hits”): 7.1%

  • Hispanic/Latino patients showed higher fibrosis by biopsy and FibroScan® (p<0.03).

  • Independent predictors of advanced fibrosis (F2–F4) included:

    • Hispanic/Latino ethnicity

    • Low plasma albumin

    • Being single

    • Having “2-hit” or “3-hit” disease overlap

  • The risk of advanced fibrosis increased markedly with multi-hit disease:

    • “2 hits” → OR 2.91 (95% CI: 1.23–7.16)

    • “3 hits” → OR 2.96×10⁷ (95% CI: 3.42–∞), p=0.0017

Conclusions:
 This study reveals that Hispanic/Latino PBC patients in Los Angeles County exhibit higher fibrosis severity, greater metabolic burden, and increased socioeconomic disadvantage compared with non-Hispanic patients. These findings highlight the need for inclusive clinical research, earlier screening in high-risk groups, and combined therapeutic approaches that address both autoimmune and metabolic components of PBC.

Summary for General Visitors

Understanding How Liver Diseases Differ Across Communities
 Doctors and researchers at the California Liver Research Institute and Pasadena Liver Center studied how Primary Biliary Cholangitis (PBC)—a chronic autoimmune liver disease—affects people of different racial and economic backgrounds in Los Angeles.

They reviewed medical records from over 180 patients, half of whom were Hispanic/Latino. Using non-invasive liver scans and biopsy results, they measured how advanced the disease was and what factors were linked to more severe liver damage.

What They Found:

  • Hispanic/Latino patients were more likely to come from economically challenged neighborhoods, have higher body weight, and also have other liver or autoimmune conditions like fatty liver (MASLD) or autoimmune hepatitis.

  • Those with multiple liver conditions—what researchers call “2-hit” or “3-hit” disease—had a much higher chance of developing advanced scarring (fibrosis) in the liver.

  • Even after adjusting for age, gender, and other factors, Hispanic/Latino patients showed more advanced stages of liver damage.

Why It Matters:
 This study shows that social, economic, and metabolic factors all influence how serious liver disease can become. It emphasizes the importance of early testing, prevention, and access to specialized care, especially in communities that are historically underrepresented in research.

Presented at:The American Association for the Study of Liver Diseases (AASLD) Annual Meeting, 2024 – Boston, MA. November 2025.