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Comparative Study
. 2018 Sep;29(9):833-844.
doi: 10.1007/s10552-018-1059-3. Epub 2018 Jul 20.

Incidence of primary liver cancer in American Indians and Alaska Natives, US, 1999-2009

Stephanie C Melkonian  1 , Melissa A Jim  2 , Brigg Reilley  3 , Jennifer Erdrich  4 , Zahava Berkowitz  5 , Charles L Wiggins  6 , Donald Haverkamp  2 , Mary C White  5
Affiliations
Comparative Study

Incidence of primary liver cancer in American Indians and Alaska Natives, US, 1999-2009

Stephanie C Melkonian et al. Cancer Causes Control. 2018 Sep.

Abstract

Purpose: To evaluate liver cancer incidence rates and risk factor correlations in non-Hispanic AI/AN populations for the years 1999-2009.

Methods: We linked data from 51 central cancer registries with the Indian Health Service patient registration databases to improve identification of the AI/AN population. Analyses were restricted to non-Hispanic persons living in Contract Health Service Delivery Area counties. We compared age-adjusted liver cancer incidence rates (per 100,000) for AI/AN to white populations using rate ratios. Annual percent changes (APCs) and trends were estimated using joinpoint regression analyses. We evaluated correlations between regional liver cancer incidence rates and risk factors using Pearson correlation coefficients.

Results: AI/AN persons had higher liver cancer incidence rates than whites overall (11.5 versus 4.8, RR = 2.4, 95% CI 2.3-2.6). Rate ratios ranged from 1.6 (Southwest) to 3.4 (Northern Plains and Alaska). We observed an increasing trend among AI/AN persons (APC 1999-2009 = 5%). Rates of distant disease were higher in the AI/AN versus white population for all regions except Alaska. Alcohol use (r = 0.84) and obesity (r = 0.79) were correlated with liver cancer incidence by region.

Conclusions: Findings highlight disparities in liver cancer incidence between AI/AN and white populations and emphasize opportunities to decrease liver cancer risk factor prevalence.

Keywords: Alaska Native; American Indian; Cancer incidence; Health disparity; Liver cancer.

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Conflict of interest statement

Compliance with ethical standards

Conflict of interest No conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
a Correlation between prevalence of binge drinking (1999–2009, excluding 2000) and liver cancer incidence rates (1999–2009) by IHS regions and sex (AI/AN population). b Correlation between prevalence of overweight/obesity and liver cancer incidence rates (1999–2009) by IHS region and sex (AI/AN population). Note: AI/AN race is reported by NPCR and SEER registries or through linkage with the IHS patient registration database. The updated bridged intercensal population estimates significantly overestimate AI/ AN populations of Hispanic origin. All analyses are limited to non-Hispanic AI/AN populations. Non-Hispanic White was chosen as the reference population. The term “non-Hispanic” is omitted when discussing both groups
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