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Clin Gastroenterol Hepatol. 2018 Dec 6. pii: S1542-3565(18)31336-3. doi: 10.1016/j.cgh.2018.11.059. [Epub ahead of print]

Significant Increase in Risk of Fibrosis or Cirrhosis at Time of HCV Diagnosis for Hispanics With Diabetes and Obesity Compared with Other Ethnic Groups.

Author information

1
Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio (UT Health San Antonio), 7703 Floyd Curl Drive, San Antonio, TX, USA 78229, USA; Center for Research to Advance Community Health (ReACH), UT Health San Antonio, 7411 John Smith Drive, Suite 1050, San Antonio, TX 78229, USA. Electronic address: turner@uthscsa.edu.
2
Department of Epidemiology and Biostatistics, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio (UT Health San Antonio), 7703 Floyd Curl Drive, San Antonio, TX, USA 78229, USA.
3
Center for Research to Advance Community Health (ReACH), UT Health San Antonio, 7411 John Smith Drive, Suite 1050, San Antonio, TX 78229, USA.
4
Department of Internal Medicine, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390.

Abstract

BACKGROUND & AIMS:

Advanced liver disease, which includes fibrosis and cirrhosis, has been reported to be more prevalent in Hispanics patients at the time of diagnosis of chronic hepatitis C virus (HCV) infection than non-Hispanic black or non-Hispanic white patients. We performed a propensity score-matched analysis to determine whether metabolic risk factors contribute to this disparity.

METHODS:

We collected data from persons with 748 HCV infection (22% Hispanic, 53% non-Hispanic black, and 26% non-Hispanic while; 23% with advanced liver disease), born from 1945 through 1965, diagnosed at 6 healthcare systems in Texas. Advanced liver disease was defined as a FIB-4 index score above 3.25. We examined the association between advanced liver disease and race-ethnicity, metabolic risk (based on diabetes mellitus and body mass index [BMI]) and heavy alcohol use in propensity score-matched analyses.

RESULTS:

In propensity-score matched models, the adjusted odds ratios (AORs) of advanced liver disease for Hispanics who were obese (BMI ≥30) with a diagnosis of diabetes were, respectively, 7.89 (95% CI, 3.66 -17.01) vs. non-Hispanic black patients and 12.49 (95% CI, 3.24 - 48.18) vs. non-Hispanic white patients (both P<.001). The adjusted odds ratios BMI<25, with or without diabetes, were more than 2-fold greater for Hispanics than non-Hispanic black or non-Hispanic white patients (both P<.002).

CONCLUSIONS:

HCV-infected Hispanics with obesity and diabetes have a far higher risk for advance liver disease than other racial or ethnic groups. These findings highlight the need for HCV treatment and management of probable concurrent fatty liver disease. Even after we accounted for metabolic risk factors, Hispanics were still at higher risk for advanced liver disease, indicating the potential involvement of other factors such as genetic variants.

KEYWORDS:

Health disparity; advanced liver disease; chronic Hepatitis C; metabolic syndrome

PMID:
30529733
DOI:
10.1016/j.cgh.2018.11.059

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