Incidence and risk factors for hepatocellular carcinoma in Texas Latinos: implications for prevention research

Abstract

Background: Hepatocellular carcinoma (HCC) is increasing in the U.S. despite a decline in cancer overall. Latinos have higher rates of HCC than the general population according to the Surveillance, Epidemiology, and End Results (SEER) Program. Not included in SEER, Texas Latinos make up one-fifth of the U.S. Latino population. To determine whether HCC incidence differs among U.S. and Texas Latinos, this descriptive study compares HCC incidence from 1995 through 2006 among three Latino populations: U.S. SEER, Texas overall and a South Texas subset. To identify lines of prevention research, we compare prevalence of known HCC risk factors among these Latino groups.

Methods: Data were collected from the U.S. SEER Program, Texas Cancer Registry and Texas Department of State Health Services (TDSHS). Annual age-specific and age-adjusted HCC incidence rates, annual percent changes (APCs) and 95% confidence intervals were calculated as well as prevalence of obesity, diabetes, heavy alcohol use and cigarette smoking.

Results: Of the three Latino groups compared, South Texas Latinos had the highest age-adjusted HCC incidence rates and SEER Latinos had the lowest (10.6/100,000 (10.1-11.1) and 7.5/100,000 (7.2-7.7), respectively). HCC incidence significantly increased over time (APCs>0) among Latinos in all three geographic groups. Between 1995 and 2006, there was an increase in obesity among all three populations, and obesity was highest among South Texas Latinos. Diabetes increased among U.S. Latinos, and Latino women in South Texas had significantly higher diabetes prevalence than U.S. Latino women. Cigarette smoking and heavy alcohol use were similar among groups.

Conclusions: The incidence of HCC among Latinos in South Texas is higher than elsewhere in the United States. Higher rates of HCC among Texas and South Texas Latinos may be associated with greater prevalence of obesity and diabetes, risk factors for HCC that are amenable to intervention.

Figure 1. Annual Age-adjusted incidence rates of hepatocellular carcinoma by ethnicity, 1995–2006.

Annual age-adjusted incidence of HCC increased over the study period and was highest among South Texas Latinos. Data for non-Latino whites (NLW) is included for general comparison purposes.

Figure 2. Age-specific incidence rates of hepatocellular carcinoma.

Age-specific incidence increases with age from 40 to 79 years. Data for non-Latino whites (NLW) is included for general comparison purposes.

Figure 3. HCC risk factor prevalence among U.S., Texas and South Texas Latinos, 1995–1997 and 2004–2006.

A) Obesity prevalence increased among all three populations of Latinos and was highest among Latinos in South Texas. B) Diabetes prevalence significantly increased among U.S. Latinos. There were also non-significant increases among Texas and South Texas Latinos. Latino women in South Texas had significantly higher diabetes prevalence than U.S. Latino women. C) Heavy alcohol use did not change significantly over time among any Latino group, though there were non-significant increases in South Texas. D) Cigarette smoking significantly declined only among U.S. Latinos. During 2004–2006, there were no significant differences among the three Latino groups.