Racial Differences in Hepatocellular Carcinoma Incidence and Risk Factors among a Low Socioeconomic Population
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Hepatocellular Carcinoma (HCC) Incidence
2.3. Population for Analysis
2.4. Statistical Analysis
3. Results
3.1. Study Population
3.2. Incidence Rates
3.3. Cox Regression Model
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | White Americans | African Americans |
---|---|---|
Number at risk | 18,678 | 48,906 |
Number of hepatocellular carcinoma cases | 57 | 237 |
Follow-up time (months; median (IQR)) | 110 (89–129) | 126 (100–145) |
Age at enrollment (years; median (IQR)) | 52 (46–59) | 50 (44–56) |
40–49 | 41.6 | 49.8 |
50–59 | 33.5 | 33.7 |
60–69 | 18.7 | 12.6 |
70–79 | 6.3 | 4.1 |
Sex, % | ||
Male | 34.3 | 41.3 |
Female | 65.7 | 58.7 |
BMI category, % | ||
Normal | 25.8 | 24.5 |
Overweight | 28.6 | 28.8 |
Obese | 44.7 | 45.7 |
Missing | 0.8 | 1.1 |
Education, % | ||
<High School | 29.0 | 33.2 |
High School | 35.4 | 35.2 |
>High School | 35.6 | 31.6 |
Missing | 0.0 | 0.0 |
Household income, % | ||
<USD 15,000 | 56.0 | 61.8 |
USD 15,000–49,999 | 34.3 | 33.5 |
>USD 50,000 | 8.6 | 3.6 |
Missing | 1.1 | 1.1 |
Self-reported hepatitis B virus infection, % | ||
No | 95.7 | 97.2 |
Yes | 2.0 | 1.5 |
Missing | 2.4 | 1.3 |
Self-reported hepatitis C virus infection, % | ||
No | 92.6 | 95.6 |
Yes | 5.0 | 3.1 |
Missing | 2.4 | 1.3 |
Diabetes, % | ||
No | 79.0 | 77.8 |
Yes | 20.7 | 22.0 |
Missing | 0.3 | 1.3 |
Among those with diabetes, use of prescription diabetes medication, % | ||
No | 19.4 | 13.3 |
Yes | 80.6 | 86.6 |
Missing | 0.0 | 0.01 |
Among those with diabetes, number of years with diabetes (years, median (IQR)) | 6 (2–12) | 7 (2–14) |
Insurance coverage, % | ||
No | 43.3 | 43.2 |
Yes | 56.0 | 56.3 |
Missing | 0.7 | 0.6 |
Use of aspirin, % a | ||
No | 85.3 | 88.2 |
Yes | 14.3 | 11.5 |
Missing | 0.4 | 0.4 |
Use of over-the-counter pain-relievers, a % | ||
No | 78.0 | 84.0 |
Yes | 21.6 | 15.6 |
Missing | 0.4 | 0.4 |
Use of prescription pain-relievers, a % | ||
No | 93.5 | 96.6 |
Yes | 6.1 | 3.1 |
Missing | 0.4 | 0.3 |
Cigarette smoking status, % | ||
Never | 30.8 | 36.4 |
Former | 25.6 | 19.2 |
Current | 43.4 | 44.2 |
Missing | 0.2 | 0.2 |
Heavy alcohol drinkers, b % | ||
No | 87.1 | 78.6 |
Yes | 11.7 | 20.4 |
Missing | 1.2 | 1.0 |
Currently employed, % | ||
No | 66.8 | 61.9 |
Yes | 32.5 | 37.5 |
Missing | 0.8 | 0.7 |
Laborer, including construction worker, c % | ||
No | 88.9 | 87.5 |
Yes | 10.4 | 11.8 |
Missing | 0.8 | 0.7 |
Dry cleaning, d % | ||
No | 98.7 | 98.3 |
Yes | 0.6 | 1.0 |
Missing | 0.8 | 0.7 |
Farming, d % | ||
No | 93.3 | 94.8 |
Yes | 5.9 | 4.6 |
Missing | 0.8 | 0.6 |
Chemical production or use, d % | ||
No | 96.0 | 97.2 |
Yes | 3.2 | 2.1 |
Missing | 0.8 | 0.7 |
No Incident Cancer | Incident HCC | Univariate | Multivariable a | |
---|---|---|---|---|
HR (95%CI) | HR (95%CI) | |||
Age at enrollment b | ||||
40 | 2644 | 6 | 0.19 (0.10–0.38) | 0.23 (0.12–0.46) |
46 | 2348 | 10 | 0.72 (0.63–0.84) | 0.71 (0.61–0.82) |
50 (Median) | 2203 | 15 | 1.00 (Ref.) | 1.00 (Ref.) |
53 | 1911 | 11 | 1.04 (0.90–1.20) | 1.12 (0.97–1.31) |
68 | 422 | 0 | 0.86 (0.58–1.28) | 1.75 (1.14–2.68) |
Sex | ||||
Female | 28,624 | 67 | 1.00 (Ref.) | 1.00 (Ref.) |
Male | 20,045 | 170 | 3.81 (2.87–5.06) | 2.05 (1.50–2.80) |
BMI category | ||||
Normal | 11,888 | 96 | 1.00 (Ref.) | 1.00 (Ref.) |
Overweight | 13,994 | 85 | 0.72 (0.54–0.96) | 0.98 (0.72–1.32) |
Obese | 22,272 | 56 | 0.30 (0.21–0.41) | 0.65 (0.45–0.95) |
Education | ||||
<High School | 16,136 | 91 | 1.00 (Ref.) | 1.00 (Ref.) |
High School | 17,128 | 91 | 0.92 (0.69–1.23) | 1.06 (0.78–1.43) |
>High School | 15,395 | 55 | 0.59 (0.42–0.83) | 0.78 (0.55–1.11) |
Household income | ||||
<USD 15,000 | 30,061 | 177 | 1.00 (Ref.) | 1.00 (Ref.) |
USD 15,000–49,999 | 16,325 | 56 | 0.55 (0.40–0.74) | 0.84 (0.61–1.17) |
>USD 50,000 | 1746 | 3 | 0.27 (0.09–0.85) | 0.53 (0.17–1.70) |
Hepatitis B | ||||
No | 47,335 | 223 | 1.00 (Ref.) | 1.00 (Ref.) |
Yes | 714 | 9 | 2.78 (1.43–5.42) | 1.82 (0.93–3.56) |
Hepatitis C | ||||
No | 46,578 | 168 | 1.00 (Ref.) | 1.00 (Ref.) |
Yes | 1471 | 64 | 13.07 (9.79–17.44) | 7.73 (5.71–10.47) |
Diabetes | ||||
No | 37,850 | 182 | 1.00 (Ref.) | 1.00 (Ref.) |
Yes | 10,720 | 55 | 1.17 (0.87–1.59) | 1.48 (1.06–2.06) |
Cigarette smoking status | ||||
Never | 17,792 | 28 | 1.00 (Ref.) | 1.00 (Ref.) |
Former | 9364 | 35 | 2.44 (1.48–4.01) | 1.45 (0.87–2.42) |
Current | 21,424 | 174 | 5.37 (3.61–8.01) | 2.91 (1.87–4.52) |
Heavy alcohol drinker c | ||||
No | 38,275 | 146 | 1.00 (Ref.) | 1.00 (Ref.) |
Yes | 9891 | 91 | 2.49 (1.92–3.24) | 1.59 (1.19–2.11) |
Currently employed | ||||
No | 30,084 | 182 | 1.00 (Ref.) | 1.00 (Ref.) |
Yes | 18,264 | 55 | 0.45 (0.33–0.61) | 0.73 (0.53–0.99) |
No Incident Cancer | Incident HCC | Univariate | Multivariable a | |
---|---|---|---|---|
HR (95%CI) | HR (95%CI) | |||
Age at enrollment b | ||||
42 | 763 | 0 | 0.52 (0.26–1.05) | 0.50 (0.24–1.04) |
52 (Median) | 665 | 6 | 1.00 (Ref.) | 1.00 (Ref.) |
66 | 313 | 1 | 0.64 (0.32–1.30) | 1.44 (0.69–3.01) |
Sex | ||||
Female | 12,248 | 19 | 1.00 (Ref.) | 1.00 (Ref.) |
Male | 6373 | 38 | 4.24 (2.44–7.35) | 2.83 (1.58–5.07) |
BMI category | ||||
Normal | 4806 | 21 | 1.00 (Ref.) | 1.00 (Ref.) |
Overweight | 5336 | 12 | 0.51 (0.25–1.03) | 0.52 (0.25–1.07) |
Obese | 8325 | 24 | 0.65 (0.36–1.16) | 0.79 (0.41–1.53) |
Education | ||||
< High School | 5395 | 20 | 1.00 (Ref.) | 1.00 (Ref.) |
High School | 6593 | 16 | 0.66 (0.34–1.27) | 0.67 (0.35–1.31) |
> High School | 6632 | 21 | 0.87 (0.47–0) | 0.82 (0.42–1.59) |
Household income | ||||
<USD 15,000 | 10,423 | 40 | 1.00 (Ref.) | 1.00 (Ref.) |
USD 15,000–49,999 | 6393 | 10 | 0.39 (0.20–0.79) | 0.54 (0.26–1.12) |
>USD 50,000 | 1601 | 7 | 1.14 (0.51–2.54) | 1.88 (0.74–4.75) |
Hepatitis B | ||||
No | 17,817 | 53 | 1.00 (Ref.) | 1.00 (Ref.) |
Yes | 361 | 4 | 3.83 (1.39–10.58) | 1.66 (0.58–4.73) |
Hepatitis C | ||||
No | 17,275 | 28 | 1.00 (Ref.) | 1.00 (Ref.) |
Yes | 903 | 29 | 22.41 (13.33–37.67) | 19.24 (10.58–35.00) |
Diabetes | ||||
No | 14,714 | 35 | 1.00 (Ref.) | 1.00 (Ref.) |
Yes | 3849 | 22 | 2.61 (1.53–4.45) | 3.55 (1.96–6.43) |
Cigarette smoking status | ||||
Never | 5739 | 11 | 1.00 (Ref.) | 1.00 (Ref.) |
Former | 4770 | 12 | 1.37 (0.60–3.10) | 0.87 (0.38–2.00) |
Current | 8069 | 34 | 2.35 (1.19–4.65) | 1.23 (0.56–2.71) |
Heavy alcohol drinker c | ||||
No | 16,234 | 42 | 1.00 (Ref.) | 1.00 (Ref.) |
Yes | 2164 | 15 | 2.53 (1.40–4.56) | 1.80 (0.95–3.42) |
Currently employed | ||||
No | 12,438 | 38 | 1.00 (Ref.) | 1.00 (Ref.) |
Yes | 6043 | 19 | 0.96 (0.55–1.67) | 1.68 (0.90–3.14) |
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Share and Cite
Muhimpundu, S.; Conway, R.B.N.; Warren Andersen, S.; Lipworth, L.; Steinwandel, M.D.; Blot, W.J.; Shu, X.-O.; Sudenga, S.L. Racial Differences in Hepatocellular Carcinoma Incidence and Risk Factors among a Low Socioeconomic Population. Cancers 2021, 13, 3710. https://doi.org/10.3390/cancers13153710
Muhimpundu S, Conway RBN, Warren Andersen S, Lipworth L, Steinwandel MD, Blot WJ, Shu X-O, Sudenga SL. Racial Differences in Hepatocellular Carcinoma Incidence and Risk Factors among a Low Socioeconomic Population. Cancers. 2021; 13(15):3710. https://doi.org/10.3390/cancers13153710
Chicago/Turabian StyleMuhimpundu, Sylvie, Rebecca Baqiyyah N. Conway, Shaneda Warren Andersen, Loren Lipworth, Mark D. Steinwandel, William J. Blot, Xiao-Ou Shu, and Staci L. Sudenga. 2021. "Racial Differences in Hepatocellular Carcinoma Incidence and Risk Factors among a Low Socioeconomic Population" Cancers 13, no. 15: 3710. https://doi.org/10.3390/cancers13153710