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Abstract Details
State-Level Hepatocellular Carcinoma Incidence and Association with Obesity and Physical Activity in the United States
Hepatology. 2021 Mar 17. doi: 10.1002/hep.31811. Online ahead of print.
Yi-Te Lee1, Jasmine J Wang12, Michael Luu3, Hsian-Rong Tseng1, Nicole E Rich4, Shelly C Lu25, Nicholas N Nissen26, Mazen Noureddin56, Amit G Singal4, Ju Dong Yang256
Author information
1California Nano Systems Institute, Crump Institute for Molecular Imaging, Department of Molecular and Medical Pharmacology, University of California, Los Angeles, CA, USA.
2Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
3Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
4Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX, USA.
5Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
6Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Abstract
Background & aims: Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related mortality, with a disproportionate impact on racial/ethnic minority groups. However, state-level variation in racial/ethnic disparities and temporal trends of HCC incidence remain unknown. Therefore, we aimed to characterize: 1) state-level racial/ethnic disparity in HCC incidence, 2) state-level temporal changes in HCC incidence, and 3) the ecological correlation between HCC incidence and obesity/physical activity levels in the US.
Approach and results: Trends in HCC incidence between 2001-2017 were calculated using data from Center for Disease Control (CDC) and Prevention's National Program of Cancer Registries and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER), and annual percent change (APC) in rates were calculated. State-level percent of obesity and level of physical activity were obtained from the CDC, and the correlation between obesity, physical activity, and state-specific average APC (AAPC) was tested by Pearson correlation coefficient. There were striking state-level racial/ethnic disparities in HCC incidence; incidence rate ratios ranged between 6.3 and 0.9 in Blacks, 6.1 and 1.7 in Asians/Pacific Islanders, 3.8 and 0.9 in Hispanics, and 6.0 and 0.9 in American Indians/Alaska Natives (compared to Whites as reference). Despite overall decreasing HCC incidence rates after 2015, HCC incidence continued increasing in 26 states over recent years. HCC incidence trends had a moderate correlation with state-level obesity (r=0.45, P<0.001) and a moderate inverse correlation with state-level physical activity (r=-0.40, P=0.004).
Conclusions: There is wide state-level variation in racial/ethnic disparity of HCC incidence. There are also disparate incidence trends across states, with HCC incidence continuing to increase in over half of states. Regional obesity and lack of physical activity have moderate correlations with HCC incidence trends, suggesting interventions targeting these factors may help curb HCC incidence.