Tags

Type your tag names separated by a space and hit enter

Local geographic variation in chronic liver disease and hepatocellular carcinoma: contributions of socioeconomic deprivation, alcohol retail outlets, and lifestyle.
Ann Epidemiol. 2014 Feb; 24(2):104-10.AE

Abstract

PURPOSE

Hepatocellular carcinoma (HCC) incidence rates continue to increase in the United States. Geographic variation in rates suggests a potential contribution of area-based factors, such as neighborhood socioeconomic deprivation, retail alcohol availability, and access to health care.

METHODS

Using the National Institutes of Health-American Association of Retired Persons Diet and Health Study, we prospectively examined area socioeconomic variations in HCC incidence (n = 434 cases) and chronic liver disease (CLD) mortality (n = 805 deaths) and assessed contribution of alcohol outlet density, health care infrastructure, diabetes, obesity, and health behaviors. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated from hierarchical Cox regression models.

RESULTS

Area socioeconomic deprivation was associated with increased risk of HCC incidence and CLD mortality (HR, 1.48; 95% CI, 1.03-2.14 and HR, 2.36; 95% CI, 1.79-3.11, respectively) after accounting for age, sex, and race. After additionally accounting for educational attainment and health risk factors, associations for HCC incidence were no longer significant; associations for CLD mortality remained significant (HR, 1.78; 95% CI, 1.34-2.36). Socioeconomic status differences in alcohol outlet density and health behaviors explained the largest proportion of socioeconomic status-CLD mortality association, 10% and 29%, respectively. No associations with health care infrastructure were observed.

CONCLUSIONS

Our results suggest a greater effect of area-based factors for CLD than HCC. Personal risk factors accounted for the largest proportion of variance for HCC but not for CLD mortality.

Authors+Show Affiliations

Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; Office of Surveillance and Epidemiology, US Food and Drug Administration, Silver Spring, MD. Electronic address: jacqueline.major@fda.hhs.gov.Cancer Control Research Program, Norris Cotton Cancer Center, Dartmouth College, Lebanon, NH.Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.Cancer Control Research Program, Norris Cotton Cancer Center, Dartmouth College, Lebanon, NH.AARP, Washington, DC.Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD.Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24332863

Citation

Major, Jacqueline M., et al. "Local Geographic Variation in Chronic Liver Disease and Hepatocellular Carcinoma: Contributions of Socioeconomic Deprivation, Alcohol Retail Outlets, and Lifestyle." Annals of Epidemiology, vol. 24, no. 2, 2014, pp. 104-10.
Major JM, Sargent JD, Graubard BI, et al. Local geographic variation in chronic liver disease and hepatocellular carcinoma: contributions of socioeconomic deprivation, alcohol retail outlets, and lifestyle. Ann Epidemiol. 2014;24(2):104-10.
Major, J. M., Sargent, J. D., Graubard, B. I., Carlos, H. A., Hollenbeck, A. R., Altekruse, S. F., Freedman, N. D., & McGlynn, K. A. (2014). Local geographic variation in chronic liver disease and hepatocellular carcinoma: contributions of socioeconomic deprivation, alcohol retail outlets, and lifestyle. Annals of Epidemiology, 24(2), 104-10. https://doi.org/10.1016/j.annepidem.2013.11.006
Major JM, et al. Local Geographic Variation in Chronic Liver Disease and Hepatocellular Carcinoma: Contributions of Socioeconomic Deprivation, Alcohol Retail Outlets, and Lifestyle. Ann Epidemiol. 2014;24(2):104-10. PubMed PMID: 24332863.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Local geographic variation in chronic liver disease and hepatocellular carcinoma: contributions of socioeconomic deprivation, alcohol retail outlets, and lifestyle. AU - Major,Jacqueline M, AU - Sargent,James D, AU - Graubard,Barry I, AU - Carlos,Heather A, AU - Hollenbeck,Albert R, AU - Altekruse,Sean F, AU - Freedman,Neal D, AU - McGlynn,Katherine A, Y1 - 2013/11/21/ PY - 2013/05/03/received PY - 2013/11/08/revised PY - 2013/11/11/accepted PY - 2013/12/17/entrez PY - 2013/12/18/pubmed PY - 2014/3/25/medline KW - Census KW - Cohort KW - Health care KW - Kernel density estimation KW - Liver cancer KW - Liver disease KW - Multilevel KW - Neighborhood KW - Socioeconomic disparities SP - 104 EP - 10 JF - Annals of epidemiology JO - Ann Epidemiol VL - 24 IS - 2 N2 - PURPOSE: Hepatocellular carcinoma (HCC) incidence rates continue to increase in the United States. Geographic variation in rates suggests a potential contribution of area-based factors, such as neighborhood socioeconomic deprivation, retail alcohol availability, and access to health care. METHODS: Using the National Institutes of Health-American Association of Retired Persons Diet and Health Study, we prospectively examined area socioeconomic variations in HCC incidence (n = 434 cases) and chronic liver disease (CLD) mortality (n = 805 deaths) and assessed contribution of alcohol outlet density, health care infrastructure, diabetes, obesity, and health behaviors. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated from hierarchical Cox regression models. RESULTS: Area socioeconomic deprivation was associated with increased risk of HCC incidence and CLD mortality (HR, 1.48; 95% CI, 1.03-2.14 and HR, 2.36; 95% CI, 1.79-3.11, respectively) after accounting for age, sex, and race. After additionally accounting for educational attainment and health risk factors, associations for HCC incidence were no longer significant; associations for CLD mortality remained significant (HR, 1.78; 95% CI, 1.34-2.36). Socioeconomic status differences in alcohol outlet density and health behaviors explained the largest proportion of socioeconomic status-CLD mortality association, 10% and 29%, respectively. No associations with health care infrastructure were observed. CONCLUSIONS: Our results suggest a greater effect of area-based factors for CLD than HCC. Personal risk factors accounted for the largest proportion of variance for HCC but not for CLD mortality. SN - 1873-2585 UR - https://www.unboundmedicine.com/medline/citation/24332863/Local_geographic_variation_in_chronic_liver_disease_and_hepatocellular_carcinoma:_contributions_of_socioeconomic_deprivation_alcohol_retail_outlets_and_lifestyle_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1047-2797(13)00444-4 DB - PRIME DP - Unbound Medicine ER -