Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Department of Urology, Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota.
Am J Prev Med. 2018 Nov;55(5 Suppl 1):S40-S48. doi: 10.1016/j.amepre.2018.05.030.
Hepatocellular carcinoma disproportionately affects minorities. Southern states have high proportions of black populations and prevalence of known risk factors. Further research is needed to understand the role of southern geography in hepatocellular carcinoma disparities. This paper examined racial disparities in hepatocellular carcinoma incidence, demographics, tumor characteristics, receipt of treatment, and all-cause mortality in southern and non-southern cancer registries.
Surveillance Epidemiology and End Results data were probed in 2015 to identify 43,868 patients diagnosed with hepatocellular carcinoma from 2000 to 2012 (5,455 in southern registries [Atlanta, Louisiana, and Rural and Greater Georgia]).
Southern registries showed steeper increases of age-adjusted hepatocellular carcinoma incidence (from 2.89 to 5.29cases/100,000 people) versus non-southern areas (from 3.58 to 5.54cases/100,000 people). Blacks were over-concentrated in southern registries (32% vs 10%). Compared with whites, blacks were significantly younger at diagnosis, more likely diagnosed with metastasis, and less likely to receive surgical therapies in both registry groups. After adjustment, blacks had a significantly higher risk of all-cause mortality compared with whites in southern (hazard ratio=1.10, p=0.007) and non-southern areas (hazard ratio=1.08, p<0.001). For overall populations, southern registries had higher risk of all-cause mortality versus non-southern registries (hazard ratio=1.13, p<0.001).
Age-adjusted incidence rates of hepatocellular carcinoma are plateauing overall, but are still rising in southern areas. Race and geography had independent associations with all-cause mortality excess risk among patients with hepatocellular carcinoma. Further studies are needed to understand the root causes of potential mortality risk excess among overall populations with hepatocellular carcinoma living in the South.
This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health.
肝细胞癌在少数族裔中发病率不成比例。南部各州拥有大量的黑人群体，并且存在已知的危险因素。需要进一步研究以了解南部地理环境在肝细胞癌差异中的作用。本文研究了南部和非南部癌症登记处中肝细胞癌发病率、人口统计学、肿瘤特征、治疗接受情况和全因死亡率的种族差异。
利用 2015 年监测、流行病学和最终结果数据，从 2000 年至 2012 年确定了 43868 名肝细胞癌患者（南部登记处有 5455 名[亚特兰大、路易斯安那和格鲁吉亚农村和大都市区]）。
与非南部地区（从 3.58 增加到 5.54 例/10 万）相比，南部登记处的年龄调整后肝细胞癌发病率增长更为陡峭（从 2.89 增加到 5.29 例/10 万）。黑人在南部登记处过度集中（32%比 10%）。与白人相比，黑人的诊断年龄明显较小，在两个登记处黑人更有可能被诊断为转移，并且接受手术治疗的可能性较小。调整后，与白人相比，黑人在南部（风险比=1.10，p=0.007）和非南部地区（风险比=1.08，p<0.001）的全因死亡率风险更高。对于总体人群，南部登记处的全因死亡率风险高于非南部登记处（风险比=1.13，p<0.001）。
尽管总体而言，肝细胞癌的年龄调整发病率趋于平稳，但南部地区仍在上升。种族和地理位置与肝细胞癌患者全因死亡率过高风险有独立关联。需要进一步研究以了解生活在南部的总体肝细胞癌人群中潜在死亡率过高的根本原因。
本文是由美国国立卫生研究院赞助的题为“非裔美国男性健康：研究、实践和政策影响”的补充材料的一部分。
