Risk Factors for Hepatocellular Carcinoma Among Patients with Chronic Hepatitis B Infection in an Urban Hospital Setting

Abstract

Background: Risk factors for hepatocellular carcinoma (HCC) have not been well documented among immigrant populations with chronic hepatitis B virus (HBV) infection, and most data come from native Asian cohorts. We conducted a case-control study to determine the risk factors associated with HCC among immigrant patients with chronic HBV in a US-based academic urban hospital setting, with the goal of further clarifying HCC risk in this key subset of patients. Methods: We identified a total of 278 patients with HCC and chronic HBV; these cases were age- and sex-matched in a 1:3 ratio with 823 non-cancer control subjects with chronic HBV. Logistic regression analyses were used to estimate the risk of HCC associated with race (with black race stratified by foreign-born status), adjusted for patient demographics and clinical conditions. Results: In the multivariate analysis, Asian race was the only risk factor associated with a statistically significant greater odds of HCC; adjusted odds ratio (aOR) 3.2 (95% CI [2.1 – 5.1]). Black patients comprised only 7% (19 of 278) of cases, and did not have increased odds of HCC. The crude OR was 0.6 (95% CI [0.3 – 1.1]) in African immigrants and 0.4 (95% CI [0.1 – 1.1]) in non-immigrant blacks. The aOR was 1.3 (95% CI [0.6 – 2.9]) in African immigrants and 0.6 (95% CI [0.2 – 1.8]) in non-immigrant blacks. Diabetes was associated with decreased HCC in the multivariate analysis aOR 0.6 (95% CI [0.4 – 0.9]). In a secondary multivariate analysis without cirrhosis in the model, alcohol was associated with HCC aOR 1.7 (95% CI [1.0 – 2.9]). We found no association between HCC and other risk factors including HCV coinfection and HIV coinfection. Conclusions: Asian patients were the only racial subgroup with an increased odds of HCC in our cohort. Our African-immigrant patients, many of whom were from Ethiopia or Somalia, were not at increased risk of HCC, which questions our current guidelines for early screening in these patients.