Disparity in Liver Cancer Incidence and Chronic Liver Disease Mortality by Nativity in Hispanics: the Multiethnic Cohort

Abstract

Background

Hepatocellular carcinoma (HCC) and chronic liver disease (CLD) are major causes of morbidity and mortality in Hispanics. Disparity in HCC incidence and CLD death by nativity in Hispanics has been reported. We assessed whether individual-level risk factors explain this disparity in a prospective study of 36,864 Hispanics (18,485 US-born and 18,379 foreign-born) in the Multiethnic Cohort.

Methods

Risk factors were assessed using baseline questionnaire and Medicare claim files. During a 19.6-year follow up, 189 incident cases of HCC and 298 CLD deaths were identified.

Results

The HCC incidence rate was almost twice as high in US-born as in foreign-born Hispanic men (44.7 vs. 23.1), but comparable in women (14.5 vs. 13.4). The CLD mortality rate was about twice as high in US-born as in foreign-born (66.3 vs. 35.1 in men; 42.2 vs. 19.7 in women). Heavy alcohol consumption was associated with HCC and CLD in foreign-born individuals, while current smoking status, Hepatitis B/C viral infection and diabetes were associated with both HCC and CLD. After adjustment for these risk factors, the hazard rate ratios (95% confidence intervals) of HCC and CLD death were 1.58 (1.00, 2.51) and 1.85 (1.25, 2.73), respectively for US-born compared to foreign-born Hispanics.

Conclusion(s)

US-born Hispanics, particularly males, are at greater risk of HCC and CLD death than foreign-born Hispanics. Overall known differences in risk factors do not account for these disparities. Future studies are warranted to identify factors that contribute to the elevated risk of HCC development and CLD death in US-born Hispanics.