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 -