Racial Differences in Hepatocellular Carcinoma Incidence and Risk Factors among a Low Socioeconomic Population

Abstract

The purpose of this study was to examine differences in risk factors associated with hepatocellular carcinoma (HCC) among White and African Americans from low socioeconomic backgrounds in the Southern Community Cohort Study (SCCS). The SCCS is a prospective cohort study with participants from the southeastern US. HCC incidence rates were calculated. Multivariable Cox regression was used to calculate HCC-adjusted hazard ratios (aHR) associated with known baseline HCC risk factors for White and African Americans, separately. There were 294 incident HCC. The incidence rate ratio for HCC was higher (IRR = 1.4, 95%CI: 1.1–1.9) in African Americans compared to White Americans. White Americans saw a stronger association between self-reported hepatitis C virus (aHR = 19.24, 95%CI: 10.58–35.00) and diabetes (aHR = 3.55, 95%CI: 1.96–6.43) for the development of HCC compared to African Americans (aHR = 7.73, 95%CI: 5.71–10.47 and aHR = 1.48, 95%CI: 1.06–2.06, respectively) even though the prevalence of these risk factors was similar between races. Smoking (aHR = 2.91, 95%CI: 1.87–4.52) and heavy alcohol consumption (aHR = 1.59, 95%CI: 1.19–2.11) were significantly associated with HCC risk among African Americans only. In this large prospective cohort, we observed racial differences in HCC incidence and risk factors associated with HCC among White and African Americans.

Most deprived Louisiana census tracts have higher hepatocellular carcinoma incidence and worse survival

“…At-risk populations, including racial/ethnic minorities, have increased rates of HCC and poorer outcomes due to individual and area-level disparities in risk factors, screening, and treatment ( 13 , 19 – 23 ). Multilevel interventions are likely needed to address the racial and economic disparities that contribute to liver cancer incidence and survival, such as differences in access to general healthcare that may impact screening and treatment for upstream risk factors such as alcohol use, obesity, and injection drug use.…”

Ethnic differences in hepatocellular carcinoma prevalence and therapeutic outcomes

“…Mahimpundu et al 71 reported a higher incidence of HCC among African Americans (10.2 per 100 000), compared to Caucasian Americans (6.3 per 100 000) 143 . The etiological factors of HCC were also found to be disproportionate, as the causative factors for HCC in African Americans were tobacco and alcohol use, compared to HCV infection and diabetes for Caucasian Americans 26 . Individuals of Hispanic ethnicity in the United States had the highest prevalence of NAFLD, with a high risk of progression to NASH 152 .…”

“… 143 The etiological factors of HCC were also found to be disproportionate, as the causative factors for HCC in African Americans were tobacco and alcohol use, compared to HCV infection and diabetes for Caucasian Americans. 26 Individuals of Hispanic ethnicity in the United States had the highest prevalence of NAFLD, with a high risk of progression to NASH. 152 Immigration has been postulated to play a major role in the higher rates of HCC within ethnic minorities in the United States, Western Europe, Australia, and Canada.…”

“… 25 Individuals of African descent have a significantly higher mortality rate from HCC compared to other ethnic groups. 26 Mathur et al 12 reported that the mortality rate in these individuals are 12%, 10%–12% and 16% greater than Caucasians, Hispanics, and Asians, respectively. 27 There are significant differences in disease burden, treatment, and outcomes of HCC, based on ethnicity and gender.…”

“…Disparities in the incidence of HCC are also significantly correlated with an individual's age, sex, socioeconomic status, and place of residence 25 . Individuals of African descent have a significantly higher mortality rate from HCC compared to other ethnic groups 26 . Mathur et al 12 reported that the mortality rate in these individuals are 12%, 10%–12% and 16% greater than Caucasians, Hispanics, and Asians, respectively 27 .…”