Journal Article

Hepatocellular carcinoma among US and non-US-born patients with chronic hepatitis B: Risk factors and age at diagnosis

Shuhart, Margaret C., Graham, Susan M., Kim, H. Nina, Kennedy, Kaitlyn, Arora, Nayan

2018

Overview

Risk factors for hepatocellular carcinoma (HCC) have not been well characterized among African immigrants with chronic hepatitis B virus (HBV) infection. We conducted a case-control study to identify demographic and clinical factors associated with HCC among a diverse cohort of patients with chronic HBV infection seen in a large academic health setting. We identified a total of 278 patients with HCC and chronic HBV seen at two medical centers in a 14-year span from January 2002 to December 2015. These cases were age- and sex-matched in a 1:3 ratio with 823 non-cancer control subjects with chronic HBV. Conditional logistic regression was used to estimate the odds of HCC by race, with black race stratified by African-born status, after adjusting for diabetes, HIV or HCV coinfection, alcohol misuse and cirrhosis. Of the 278 HCC cases, 67% were 60 years of age or older, 78% were male, 87% had cirrhosis and 72% were Asian. HIV infection was present in 6% of cases. Only 7% (19 of 278) of HCC cases were black, of whom 14 were African immigrants. The median age at HCC diagnosis was 44 years in Africans. Notably, nearly all (93%) of the African-born patients with HCC were diagnosed at an age younger than 60 years compared with 52% of Asian cases (P<0.001). The main factors independently associated with greater odds of HCC overall were Asian race (adjusted odds ratio [aOR] 3.3, 95% confidence interval [CI] 1.9-5.5) and cirrhosis (aOR 19.7, 95% CI 12.2-31.8). African immigrants accounted for a small proportion of HBV-associated HCC cases overall compared with Asians but appeared to have greater likelihood of early-onset HCC. Optimal strategies for HCC prevention in these key subroups with chronic HBV warrant further study.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Age / Alcoholic beverages / Asian Americans / Biology and life sciences / Chronic infection / Cirrhosis / Confidence intervals / Demographics / Diabetes / Diabetes mellitus / Diagnosis / Gastroenterology / Health care facilities / Hepatitis / Hepatitis B / Hepatocellular carcinoma / Hepatology / HIV / Human immunodeficiency virus / Identification methods / Immigrants / Infections / Infectious diseases / Liver cancer / Liver cirrhosis / Medical diagnosis / Medicine / Medicine and Health Sciences / Noncitizens / Patients / People and Places / Physical Sciences / Population / Race / Risk analysis / Risk factors / Sexually transmitted diseases / Statistical analysis / STD / Surveillance / Viruses