Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; Office of Surveillance and Epidemiology, US Food and Drug Administration, Silver Spring, MD.
Cancer Control Research Program, Norris Cotton Cancer Center, Dartmouth College, Lebanon, NH.
Ann Epidemiol. 2014 Feb;24(2):104-10. doi: 10.1016/j.annepidem.2013.11.006. Epub 2013 Nov 21.
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.
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.
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.
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.
在美国，肝细胞癌（HCC）的发病率继续上升。发病率的地域差异表明，基于区域的因素可能有一定的影响，例如邻里社会经济贫困、零售酒精供应和获得医疗保健的机会。
利用美国国立卫生研究院-美国退休人员协会饮食与健康研究，我们前瞻性地研究了 HCC 发病率（n=434 例）和慢性肝病（CLD）死亡率（n=805 例死亡）的区域社会经济差异，并评估了酒精销售点密度、医疗保健基础设施、糖尿病、肥胖和健康行为的贡献。使用分层 Cox 回归模型估计危险比（HR）和 95%置信区间（CI）。
在考虑了年龄、性别和种族后，区域社会经济贫困与 HCC 发病率和 CLD 死亡率升高相关（HR，1.48；95%CI，1.03-2.14 和 HR，2.36；95%CI，1.79-3.11）。在进一步考虑了教育程度和健康风险因素后，HCC 发病率的相关性不再显著；CLD 死亡率的相关性仍然显著（HR，1.78；95%CI，1.34-2.36）。酒精销售点密度和健康行为方面的社会经济地位差异分别解释了社会经济地位与 CLD 死亡率关联的最大比例，分别为 10%和 29%。没有观察到与医疗保健基础设施的关联。
我们的结果表明，区域因素对 CLD 的影响大于 HCC。个人风险因素对 HCC 的变异解释比例最大，但对 CLD 死亡率无影响。
