Chronic liver disease in Aboriginal North Americans

Table 1 Chronic liver disease mortality rates by etiology, Aboriginal group, and nation (number of deaths per 100 000)

Etiology	AI/AN	General US population	General Canadian population
Alcohol	19	4.6	3
Hepatitis C	2.3	1.7	1.3
Hepatitis B	0.6	0.4	1.31
Primary biliary cirrhosis	0.1	0.2	N/A
No identified cause	7.7	5.1	N/A
Overall	25.5-28.7	10.4-11.6	6.2-15.4

¹Canadian data did not include separate categories for hepatitis B and C. Data not available on Canadian First Nations peoples and native Greenla-nders specifically. Data adapted from Statistics Canada[71] and Vong[4].

Table 2 Major causes of viral hepatitis in Aboriginal North Americans

Aboriginal group	Study populations	Hepatitis A	Hepatitis B	Hepatitis C	Comments
Native Americans	South Dakota NA Navajo NA Urban and Veterans populations	Pre-vaccine incidence was 96/100 000 Seroprevalence: 76%	N/A	Seroprevalence range: 3%-32%	Hepatitis A incidence now is comparable to general population: 1.0-2.0/100 000
Alaska Natives	Random distribution of AN tribes	49% seroprevalance pre-vaccination	6% sAg+, 24% core IgG+	0.8% seroprevalance	Heavy burden of hepatitis a prior to vaccination. Hepatitis B endemic to AN with high rates of HCC in certain regions, vaccination has lead to decreased incidence
First Nations (Canada)	Manitoba FN British Columbia FN Inuit	Seroprevalence of 90% in those < 40 yr; 31/100 000 incidence pre-vaccine	5% sAg+, 27% core IgG+ in circumpolar regions, much lower outside circumpolar areas	1.1% seroprevalence in Inuit, 2%-20% in non-Inuit	Similar patterns of hepatitis as seen in US.
Native Greenlanders (Inuit)	Inuit	54% seroprevalence	7%-12% sAg+, 42% core IgG+	< 1% seroprevalence	Hepatitis B may be spread sexually more frequently than other Aboriginal populations. HCC also less common