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Cancer. 2018 Sep 1;124(17):3551-3559. doi: 10.1002/cncr.31598. Epub 2018 Aug 16.

Disparities in hepatocellular carcinoma incidence by race/ethnicity and geographic area in California: Implications for prevention.

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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.
Asian Liver Center, Stanford University School of Medicine, Palo Alto, California.
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California.
Department of Population Sciences, City of Hope, Duarte, California.
Cancer Prevention Institute of California, Fremont, California.
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
Department of Medicine, Stanford University School of Medicine, Stanford, California.
Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California.
Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California.



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.


cancer registry; geographic analysis; hepatocellular carcinoma; racial disparity; targeted prevention

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