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. 2014 Feb;24(2):104-10.
doi: 10.1016/j.annepidem.2013.11.006. Epub 2013 Nov 21.

Local geographic variation in chronic liver disease and hepatocellular carcinoma: contributions of socioeconomic deprivation, alcohol retail outlets, and lifestyle

Jacqueline M Major  1 , James D Sargent  2 , Barry I Graubard  3 , Heather A Carlos  2 , Albert R Hollenbeck  4 , Sean F Altekruse  5 , Neal D Freedman  3 , Katherine A McGlynn  3
Affiliations

Local geographic variation in chronic liver disease and hepatocellular carcinoma: contributions of socioeconomic deprivation, alcohol retail outlets, and lifestyle

Jacqueline M Major et al. Ann Epidemiol. 2014 Feb.

Abstract

Purpose: Hepatocellular carcinoma (HCC) incidence rates continue to increase in the United States. Geographic variation in rates suggests a potential contribution of area-based factors, such as neighborhood socioeconomic deprivation, retail alcohol availability, and access to health care.

Methods: Using the National Institutes of Health-American Association of Retired Persons Diet and Health Study, we prospectively examined area socioeconomic variations in HCC incidence (n = 434 cases) and chronic liver disease (CLD) mortality (n = 805 deaths) and assessed contribution of alcohol outlet density, health care infrastructure, diabetes, obesity, and health behaviors. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated from hierarchical Cox regression models.

Results: Area socioeconomic deprivation was associated with increased risk of HCC incidence and CLD mortality (HR, 1.48; 95% CI, 1.03-2.14 and HR, 2.36; 95% CI, 1.79-3.11, respectively) after accounting for age, sex, and race. After additionally accounting for educational attainment and health risk factors, associations for HCC incidence were no longer significant; associations for CLD mortality remained significant (HR, 1.78; 95% CI, 1.34-2.36). Socioeconomic status differences in alcohol outlet density and health behaviors explained the largest proportion of socioeconomic status-CLD mortality association, 10% and 29%, respectively. No associations with health care infrastructure were observed.

Conclusions: Our results suggest a greater effect of area-based factors for CLD than HCC. Personal risk factors accounted for the largest proportion of variance for HCC but not for CLD mortality.

Keywords: Census; Cohort; Health care; Kernel density estimation; Liver cancer; Liver disease; Multilevel; Neighborhood; Socioeconomic disparities.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Association between area-level socioeconomic deprivation quintiles and CLD mortality. Risk estimates account for age, sex, race, education, marital status, diabetes, body mass index, cigarette smoking, perceived health status, alcohol consumption, energy (non-alcohol), total meat intake, total fruit intake, total vegetable intake, and saturated fat intake.
See this image and copyright information in PMC

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