Hepatitis C Virus Infection, Age, and Hispanic Ethnicity Increase Mortality From Liver Cancer in the United States

Clinical Gastroenterology and Hepatology
Volume 8, Issue 8 , Pages 718-723, August 2010

Zobair M. Younossi, Maria Stepanova

published online 03 May 2010.

Abstract

Backround & Aims
We performed a population-based study to assess factors that are associated independently with hepatocellular carcinoma (HCC)-related mortality.

Methods
We evaluated clinicodemographic, laboratory, and mortality data collected from 15,866 individuals in the Third National Health and Nutrition Examination Survey from 1988 to 1994. The etiology of chronic liver disease was determined using serologic tests to measure hepatitis C virus (HCV) RNA, hepatitis B surface antigen, and iron; excessive alcohol consumption and nonalcoholic fatty liver disease (NAFLD) were determined. Cohorts were compared with controls using a stratum-specific chi-square test. The Cox proportional hazard model was used to identify independent predictors of HCC-related mortality.

Results
After a follow-up period of 160 months, 14.55% of the individuals died; 83 deaths were liver-related (25 HCC and 58 non-HCC liver related). Factors that independently predicted HCC-related mortality were age (hazard ratio [HR], 1.10; 95% confidence interval [CI], 1.04–1.16; P = .0021), Hispanic ethnicity (HR, 5.14; 95% CI, 1.75–15.06; P = .0036), and HCV infection (HR, 18.12; 95% CI, 3.57–91.98; P = .0008). Factors that independently predicted non-HCC liver-related mortality included age (HR, 1.07; 95% CI, 1.04–1.10; P < .0001), male sex (HR, 3.29; 95% CI, 1.15–9.42; P = .0277), alcoholic liver disease (HR, 10.81; 95% CI, 1.32–88.26; P = .0271), HCV (HR, 27.00; 95% CI, 4.70–155.1; P = .0004), iron overload (HR, 6.18; 95% CI, 1.82–20.97; P = .0043), or NAFLD (HR, 11.56; 95% CI, 3.21–41.67; P = .0004).

Conclusions
This population-based study showed that HCV infection and Hispanic ethnicity independently increase the risk for HCC-related mortality. All liver diseases, including NAFLD, increase the risk for non-HCC liver-related mortality.

Keywords: Hepatocelluar Carcinoma, Liver-Related Mortality, Liver Neoplasm

Abbreviations used in this paper: ALD, alcoholic liver disease, CH-C, chronic hepatitis C, CI, confidence interval, DM, diabetes mellitus, HCC, hepatocellular carcinoma, HCV, hepatitis C virus, HR, hazard ratio, ICD, International Classification of Diseases, NAFLD, nonalcoholic fatty liver disease, NDI, National Death Index, NHANES III, Third National Health and Nutrition Examination Survey, SEER, Surveillance, Epidemiology End Result

Conflicts of interest The authors disclose no conflicts.

Funding This study was supported in part by the Liver Outcomes Research Fund, The Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, Virginia.

PII: S1542-3565(10)00431-3
doi:10.1016/j.cgh.2010.04.017
© 2010 AGA Institute. Published by Elsevier Inc. All rights reserved.

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