Stanford Cancer Institute, Stanford University School of Medicine, Palo Alto, California.
Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, California.
Cancer. 2018 Sep 1;124(17):3551-3559. doi: 10.1002/cncr.31598. Epub 2018 Aug 16.
The incidence of hepatocellular carcinoma (HCC) has been rising rapidly in the United States. California is an ethnically diverse state with the largest number of incident HCC cases in the country. Characterizing HCC disparities in California may inform priorities for HCC prevention.
By using data from the Surveillance, Epidemiology, and End Results 18-Registry Database and the California Cancer Registry, age-adjusted HCC incidence in California from 2009 through 2013 was calculated by race/ethnicity and neighborhood ethnic enclave status. A geographic analysis was conducted using Medical Service Study Areas (MSSAs) as the geographic unit, and race/ethnicity-specific standardized incidence ratios (SIRs) were calculated to identify MSSAs with higher-than-expected HCC incidence compared with the statewide average.
During 2009 through 2013, the age-adjusted incidence of HCC in California was the highest in Asians/Pacific Islanders (APIs) and Hispanics (>100% higher than whites), especially those living in more ethnic neighborhoods (20%-30% higher than less ethnic neighborhoods). Of the 542 MSSAs statewide, 42 had elevated HCC incidence (SIR ≥ 1.5; lower bound of 95% confidence interval > 1) for whites, 14 for blacks, 24 for APIs, and 36 for Hispanics. These MSSAs have 24% to 52% higher proportions of individuals below the 100% federal poverty line than other MSSAs.
APIs and Hispanics residing in more ethnic neighborhoods and individuals residing in lower income neighborhoods require more extensive preventive efforts tailored toward their unique risk factor profiles. The current race/ethnicity-specific geographic analysis can be extended to other states to inform priorities for HCC targeted prevention at the subcounty level, eventually reducing HCC burden in the country.
肝细胞癌 (HCC) 的发病率在美国迅速上升。加利福尼亚州是一个种族多样化的州，其 HCC 发病例数居全国首位。描述加利福尼亚州的 HCC 差异情况可能有助于为 HCC 预防确定重点。
利用来自监测、流行病学和最终结果 18 登记数据库和加利福尼亚癌症登记处的数据，根据种族/族裔和邻里族裔飞地状况，计算了 2009 年至 2013 年加利福尼亚州的年龄调整 HCC 发病率。采用医疗服务研究区 (MSSA) 作为地理单位进行地理分析，并计算了特定种族/族裔的标准化发病比 (SIR)，以确定与全州平均水平相比 HCC 发病率较高的 MSSA。
在 2009 年至 2013 年期间，加利福尼亚州 HCC 的年龄调整发病率在亚洲/太平洋岛民 (API) 和西班牙裔人群中最高（比白人高 100%以上），尤其是居住在族裔聚居区的人群（比族裔较少的聚居区高 20%-30%）。在全州的 542 个 MSSA 中，有 42 个 MSSA 的 HCC 发病率较高（SIR≥1.5；95%置信区间下限>1），白人占 42 个，黑人占 14 个，API 占 24 个，西班牙裔占 36 个。这些 MSSA 的 100%联邦贫困线以下的人口比例比其他 MSSA 高 24%至 52%。
居住在族裔聚居区的 API 和西班牙裔以及居住在收入较低社区的个人需要更广泛的、针对其独特风险因素的预防措施。目前的种族/族裔特定地理分析可以扩展到其他州，以确定在亚县级别的 HCC 针对性预防重点，最终降低全国的 HCC 负担。
