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Ann Epidemiol. 2014 Feb;24(2):104-10. doi: 10.1016/j.annepidem.2013.11.006. Epub 2013 Nov 21.

Local geographic variation in chronic liver disease and hepatocellular carcinoma: contributions of socioeconomic deprivation, alcohol retail outlets, and lifestyle.

Author information

1
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; Office of Surveillance and Epidemiology, US Food and Drug Administration, Silver Spring, MD. Electronic address: jacqueline.major@fda.hhs.gov.
2
Cancer Control Research Program, Norris Cotton Cancer Center, Dartmouth College, Lebanon, NH.
3
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.
4
AARP, Washington, DC.
5
Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD.

Abstract

PURPOSE:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

KEYWORDS:

Census; Cohort; Health care; Kernel density estimation; Liver cancer; Liver disease; Multilevel; Neighborhood; Socioeconomic disparities

PMID:
24332863
PMCID:
PMC3946391
DOI:
10.1016/j.annepidem.2013.11.006
[Indexed for MEDLINE]
Free PMC Article

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