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. 2020 May;40(5):1201-1210.
doi: 10.1111/liv.14409. Epub 2020 Mar 8.

The association between etiology of hepatocellular carcinoma and race-ethnicity in Florida

Paulo S Pinheiro  1 , Heidy N Medina  2 , Karen E Callahan  3 , Patricia D Jones  4 , Clyde P Brown  5 , Sean F Altekruse  6 , Katherine A McGlynn  7 , Erin N Kobetz  8
Affiliations

The association between etiology of hepatocellular carcinoma and race-ethnicity in Florida

Paulo S Pinheiro et al. Liver Int. 2020 May.

Abstract

Background and aim: The incidence of hepatocellular carcinoma (HCC) has risen considerably in the US since 1980. The main causes include metabolic disorders (NAFLD, diabetes, obesity, metabolic syndrome), alcohol-related disease (ALD) and hepatitis C and B virus infections (HCV, HBV). Etiology-specific HCC incidence rates by detailed race-ethnicity are needed to improve HCC control and prevention efforts.

Methods: All HCC cases diagnosed in Florida during 2014-2015 were linked to statewide hospital discharge data to determine etiology. Age-specific and age-adjusted rates were used to assess the intersection between etiology and detailed racial-ethnicities, including White, African American, Afro-Caribbean, Asian, Cuban, Puerto Rican and Continental Hispanic (Mexican, South and Central American).

Results: Of 3666 HCC cases, 2594 matched with discharge data. HCV was the leading cause of HCC among men and women (50% and 43% respectively), followed by metabolic disorders (25% and 37%) and ALD (16% and 9%). Puerto Rican and African American men had the highest HCV-HCC rates, 7.9 and 6.3 per 100 000 respectively. Age-specific rates for HCV-HCC peaked among baby boomers (those born in 1945-1965). Metabolic-HCC rates were highest among populations above age 70 and among Continental Hispanics. Afro-Caribbean men had high rates of HBV-HCC, whereas Puerto Rican men had high ALD-HCC.

Conclusions: HCC etiology is associated with specific race/ethnicity. While HCV-related HCC rates are projected to decrease soon, HCC will continue to affect Hispanics disproportionately, based on higher rates of metabolic-HCC (and ALD-HCC) among Continental Hispanics, who demographically represent 80% of all US Hispanics. Multifaceted approaches for HCC control and prevention are needed.

Keywords: African American; Caribbean; Cuban; Florida; HBV; HCV; NAFLD; Puerto Rican; alcohol-liver disease; cause; ethnicity; etiology; hepatocellular carcinoma; incidence; race; subgroup.

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Conflict of interest statement

Conflict of Interest Statement: The authors declare no potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Etiology-specific age-specific rates per 100,000 by sex and detailed race-ethnicity. Florida 2014–2015. Yellow represents HCV, green represents MTB, blue represents ALD, and orange represents HBV. Abbreviations: HCV (Hepatitis C Virus); MTB (Metabolic); ALD (Alcoholic Liver Disease); HBV (Hepatitis B Virus)
Figure 1.
Figure 1.
Etiology-specific age-specific rates per 100,000 by sex and detailed race-ethnicity. Florida 2014–2015. Yellow represents HCV, green represents MTB, blue represents ALD, and orange represents HBV. Abbreviations: HCV (Hepatitis C Virus); MTB (Metabolic); ALD (Alcoholic Liver Disease); HBV (Hepatitis B Virus)
Figure 1.
Figure 1.
Etiology-specific age-specific rates per 100,000 by sex and detailed race-ethnicity. Florida 2014–2015. Yellow represents HCV, green represents MTB, blue represents ALD, and orange represents HBV. Abbreviations: HCV (Hepatitis C Virus); MTB (Metabolic); ALD (Alcoholic Liver Disease); HBV (Hepatitis B Virus)
Figure 1.
Figure 1.
Etiology-specific age-specific rates per 100,000 by sex and detailed race-ethnicity. Florida 2014–2015. Yellow represents HCV, green represents MTB, blue represents ALD, and orange represents HBV. Abbreviations: HCV (Hepatitis C Virus); MTB (Metabolic); ALD (Alcoholic Liver Disease); HBV (Hepatitis B Virus)
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