Johnson Corianne R, Muhimpundu Sylvie, Han Xijing, Mumma Michael T, Shrubsole Martha J, Zheng Wei, Spalluto Lucy B, Lipworth Loren, Sudenga Staci L
Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
International Epidemiology Institute, Rockville, Maryland.
Cancer Epidemiol Biomarkers Prev. 2025 Feb 6;34(2):348-354. doi: 10.1158/1055-9965.EPI-24-1119.
Hepatocellular carcinoma (HCC) is becoming a leading cause of cancer-related mortality in the United States, with notable disparities observed among racial and ethnic minorities. The objective of this study is to examine the association between social determinants of health (SDoH) and HCC incidence by race (White and Black individuals) using data from the Southern Community Cohort Study.
The Southern Community Cohort Study is a prospective cohort study with participants recruited from 2002 to 2009. Incident HCC cases were identified during follow-up. Exposure measures, including residential segregation, social vulnerability, population density, rurality, and poverty, were assessed at baseline. Cox proportional hazards regression models were used to estimate HRs associated with SDoH by race with the adjustment of known HCC risk factors.
Among the 79,367 eligible participants, there were 491 incident HCC cases diagnosed, 378 of whom were in Black individuals. In Black individuals, increased population density and urban residency were associated with an increased risk of HCC, even after adjusting for potential confounders [HR = 1.49; 95% confidence interval (CI), 1.04-2.13; HR = 1.70; 95% CI, 1.20-2.41, respectively]. White individuals living in the least segregated areas (HR = 2.83; 95% CI, 1.39-5.78) and in urban settings (HR = 2.34; 95% CI, 1.17-4.65) had an increased HCC risk, whereas population density was not associated with risk.
We found that individuals residing in urban populations had an increased risk of HCC. These findings underscore the complex interplay of SDoH factors and geographic influences on HCC disparities.
Our findings highlight the need for targeted interventions and further research to address HCC health inequities.
肝细胞癌（HCC）正成为美国癌症相关死亡的主要原因，在种族和少数族裔中存在显著差异。本研究的目的是利用南方社区队列研究的数据，按种族（白人和黑人个体）研究健康的社会决定因素（SDoH）与HCC发病率之间的关联。
南方社区队列研究是一项前瞻性队列研究，参与者于2002年至2009年招募。在随访期间确定HCC发病病例。在基线时评估暴露指标，包括居住隔离、社会脆弱性、人口密度、农村地区和贫困情况。使用Cox比例风险回归模型，在调整已知的HCC危险因素后，按种族估计与SDoH相关的风险比（HR）。
在79367名符合条件的参与者中，诊断出491例HCC发病病例，其中378例为黑人个体。在黑人个体中，即使在调整潜在混杂因素后，人口密度增加和城市居住与HCC风险增加相关[HR = 1.49；95%置信区间（CI），1.04 - 2.13；HR = 1.70；95% CI，1.20 - 2.41，分别]。生活在隔离程度最低地区（HR = 2.83；95% CI，1.39 - 5.78）和城市环境中的白人个体（HR = 2.34；95% CI，1.17 - 4.65）HCC风险增加，而人口密度与风险无关。
我们发现居住在城市人口中的个体HCC风险增加。这些发现强调了SDoH因素与地理因素对HCC差异的复杂相互作用。
我们的发现凸显了针对性干预措施和进一步研究以解决HCC健康不平等问题的必要性。
